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Columbia  ®nibersiitp\'^o'^ 
mtf)eCitpofi^etD|9orfe 

COLLEGE  OF  PHYSICLA.NS 
AND   SURGEONS 


Reference  Library 

Given  by 


AIE,    FOOD    AND    EXEHCISES. 


AIR, 
FOOD  AND  EXERCISES 

AN     ESSAY 

ON   THE   PEBDISPOSING   CAUSES  OF  DISEASE. 


BY 

A.   RABAGLIATI,  M.A.,  M.D.,  F.E.C.S.,  Edin., 

HONORARY  GYNECOLOGIST,  AND  LATE  SENIOR  HONORARY  SURGEON,  BRADFORD 
ROYAL  INFIRMARY  ;  CONSULTING  SURGEON  TO  BINGLEY  HOSPITAL,  TO 
BRADFORD  CHILDREN'S  HOSPITAL,  AND  TO  THE  BRADFORD 
HOME  FOR  CANCER  AND  INCURABLES. 


THIRD   EDITION, 

GEBATLY    ENLAEGED    AND   ALMOST    ENTIRELY   EB-WEITTEN. 


NEW    TOEK: 
WILLIAM    WOOD    AND     COMPANY 

MGMIV. 


Digitized  by  tine  Internet  Arciiive 

in  2010  witii  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/airfoodexercisesOOraba 


PREFACE. 


T  HOPE  that  the  chief  proposition  of  this  essay 
has  been  made  so  plain  that  I  need  say  but 
httle  in  the  way  of  preface.  A  critic  of  the 
first  edition  said  that  it  was  written  for  the  public, 
as  distinguished  from  the  medical  profession.  I 
thought  I  detected  a  certain  (or  uncertain)  air  of 
reproach  in  his  tone,  as  if  he  meant  distantly  to 
insinuate  a  suggestion  of  unprofessionalism  in  the 
behaviour  of  a  doctor  who  should  write  for  the 
public.  As  a  fact,  the  first  edition  was  written,  so 
far  as  I  know,  for  the  medical  profession.  It 
appeared  as  a  series  of  articles  in  the  Scalpel,  a 
journal  read  only  by  the  medical  profession.  No 
doubt  after  its  separate  publication,  the  public 
read  the  essay  eagerly,  the  first  edition  being 
exhausted  before  a  single  medical  criticism  had 
appeared.  The  second  edition  was  as  rapidly 
cleared  out ;  and  no  doubt  another  edition  or 
two  might  have  been  disposed  of.  But  I 
was  not  quite  satisfied  to  go  on  with  the 
work  in  the  form  which  it  had  in  1896.  In 
the  original  preface  I  had  suggested  that  I 
might  amplify  my  observations  if  the  essay  was 
received    favourably.       But    in    the    intermediate 


vi.  PREFACE, 

period  between  the  publication  of  the  second 
edition  and  any  new  one,  I  thought  I  ought  to 
appeal  to  the  medical  profession  directly  and  solely, 
before  appealing  to  the  public  in  a  matter  in  which 
both  the  profession  and  the  public  are  most  deeply 
interested,  and  which  seems  to  me  indeed  to  be 
of  the  most  vital  importance  to  both.  Accordingly 
I  wrote  in  1901  a  book  entitled  "Aphorisms, 
Definitions,  Reflections  and  Paradoxes  :  Medical, 
Surgical,  and  Dietetic."  This  being  sent  to  various 
medical  journals,  elicited  a  few  reviews,  some 
depreciatory,  and  some  highly  laudatory ;  but  on 
the  whole  the  book  fell  flat,  some  critics  even 
hinting  that  the  language  was  too  technical,  a 
rather  curious  criticism  of  a  book  addressed  and 
dedicated  to  a  learned  profession.  This  being  so, 
I  had  to  consider  what  I  should  do.  It  is  rather  a 
fine  point  to  say  what  a  medical  man  ought  to  do 
when  he  is  not  attached  to  a  medical  school,  and 
yet  feels  that  he  has  something  very  important 
to  say  on  professional  subjects.  The  direct  appeal 
that  I  made  to  the  medical  profession  fell  on  deaf 
ears.  A  few  private  letters  of  a  more  or  less 
appreciative  kind  did  not  seem  to  me  a  sufficient 
answer  to  the  question  I  addressed  to  my  colleagues 
— How  is  it  that  when  we  know  as  physiologists 
that  there  is  twice  or  thrice  as  much  lymph  in  the 
body  as  there  is  of  blood,  no  use  whatever  is  made 
of  this  fact  in  medical  practice  ?  This  overplus  of 
lymph  collected  in  the  connective  tissue  of  the 
body  appears  to  me  to  be  the  basis  on  which  the 


PBEFACE.  vii. 

great  mass  of  disease  is  built.  It  appears  to  me  to 
be  of  the  very  utmost  consequence  as  regards  the 
causation,  the  treatment,  and  the  prevention  of 
disease.  And  my  colleagues  having  as  a  body 
ignored  the  question  (although  a  few  of  them  seem 
to  have  been  greatly  and  effectively  interested  in 
it)  I  have  felt  myself  compelled,  in  view  of  the 
shortness  of  life  and  of  the  probability  that  I 
cannot  in  the  nature  of  things  expect  to  have 
many  more  opportunities  of  addressing  either  my 
colleagues  or  the  public,  to  appeal  at  once  to  as 
wide  an  audience  as  I  can.  This  book  is,  then, 
written  frankly  for  the  public,  in  the  hope  that  its 
perusal  may  simplify  and  clarify  their  ideas  upon 
the  subject  of  disease,  and  that,  by  having  their 
attention  directed  to  its  chief  cause,  as  I  conceive 
it,  they  may  be  enabled  to  considerably  increase  the 
length  of  efficient  and  healthy  life,  as  also  to  obtain 
some  amount  of  relief  from  the  calamities  which, 
in  spite  of  all  the  advances  of  medicine  and 
surgery,  they  still  are  called  upon  to  endure. 

A.  K 


Bbadfoed, 

December,  1903. 


TABLE    OF    CONTENTS. 


"^AGE  1 :  Inteodugtion.  Meaning  of  the  word  Medicine. 
*-»  Prevention  of  Disease.  Cure.  Prevention  implies  know- 
ledge of  causes ;  cure  not.  P.  2  :  Treatment  implies  three  things 
usually — rest,  medicine,  alteration  of  food.  P.  3  :  Prevention 
at  present  applied  only  to  fevers,  but  applicable  to  all  diseases. 
Do  fevers  depend  on  wrong  feeding  or  bad  air  ?  Opinion  of 
Moses.  Means  for  prevention  dependent  on  the  opinions  we 
hold.  P.  4  :  Is  feeding  or  respiration  the  more  important 
physiologically  ?  P.  6  :  Medicine  a  difficult  pursuit ;  proved 
by  differences  in  view  among  experts.  Pp.  7-9  :  As  in  other 
departments  of  knowledge,  better  medical  theories  will  replace 
worse  ones.  P.  9  :  When  medical  experts  differ,  reason  and 
judgment  must  decide.  But  other  experts  differ  from  their 
colleagues  as  much  or  more  than  doctors.  P.  10  :  A  difficulty 
in  medicine  is  caused  by  the  large  number  of  diBcases  with 
which  she  has  to  deal.  P.  11  :  Why  one  part  is  affected 
rather  than  another.  Least  resistance.  Pp.  12,  13  :  Scientific 
explanations  unsatisfactory,  and  often  may  involve  circular 
reasoning.  Medicine  deals  with  states  of  the  organism ; 
another  reason  for  her  obscurity.  P.  14  :  Order  and  light  in 
medicine  to  be  obtained  by  study  of  circulation  of  blood  and 
lymph.  P.  15  :  Eegions  of  science  in  which  medicine  has 
advanced.  Difficulty  from  the  personal  equation.  P.  16  : 
Difficulty  from  unwillingness  of  men  to  exercise  self-restraint. 
P.  17  :  And  from  fear  on  the  part  of  doctors  to  say  unpleasant 
things.  Pp.  18-20 :  Can  we  define  health  ?  Attempts  at 
definition. 

Pages  21-52  :  Chaptee  I.,  Present  State  and  Past  Progress. 
of  Medicine.     Pp.  21-3  :  Too  much  surgery ;  unscientific  and 


X.  TABLE    OF    CONTENTS. 

iiaphysiological  and  arrogant  mental  attitude  of  some  surgeons. 
Removal  of  the  appendix  vermiformis.  P.  23  :  Must  attend 
to  causes  if  we  wish  to  prevent,  e.g.,  return  of  tumours  after 
removal.  P.  24  :  Causes  of  simple  tumour  and  of  cancer  the 
same.  P.  25  :  Surgery,  though  more  successful  than  formerly, 
has  done  very  little  to  lengthen  general  duration  of  life. 
Medicine  (including  hygiene')  has  done  much  more.  Pp.  26-8  : 
Gains  to  life  effected  by  medicine.  Pp.  28-31  :  Special  gains 
in  reduction  of  fever  and  consumption.  Pp.  32-6  :  Analysis 
of  gains  in  duration  of  life,  effected  chiefly  by  attention  to  air 
supply.  P.  37  :  In  writer's  opinion,  effects  of  food  greater 
than  effects  of  air.  Pp.  37-41  :  Contributory  causes  of  gains 
by  medicine.  Diminution  of  the  birth-rate.  Going  on  in  all 
European  countries,  and  probably  also  in  America.  How  it 
-acts.  Pp.  42-4  :  Analysis  of  effects  of  low  birth-rate.  Facts 
relating  thereto.  Differences  between  birth-rates  in  towns 
quite  near  to  one  another.  P.  44  :  Low  birth-rate  lowers 
death-rate.  P.  45  :  Great  mortality  among  infants  and 
children.  Opinions  of  medical  officers  of  health  as  to  causes 
of  this.  Wrong  feeding  a  potent  cause.  P.  47  :  How  a  low 
birth-rate  lowers  the  death-rate.  A  low  birth-rate  also  lowers 
fever  mortality.  How.  P.  48  :  Mortality  of  infants  under 
one  year  old  has  not  improved  in  recent  years.  P.  49  :  If 
children  survive  five  years  of  age,  why  should  they  not  live  to 
old  age  ?  P.  50  :  Deaths  from  accident  not  more  numerous 
than  they  were.  Pp.  51-2:  Summary  of  gains;  fevers  and 
consumption  have  been  reduced  about  a  half ;  and  a  consider- 
able increase  has  been  made  to  life,  particularly,  however,  at 
the  two  extremes  of  infancy  and  old  age. 

Pages  53-68  :  Chapter  II.,  Principal  Causes  of  Mortality. 
P.  53  :  Bronchitis  the  commonest  cause  of  death.  Pneumonia 
the  next  commonest.  Proportional  numbers.  P.  54  :  Causes 
of.  Attributed  to  cold.  General  effect  of  alimentation.  Heat 
as  a  cause  of  disease.  Predisposition  to  disease ;  what  it 
means.  Pp.  55-7  :  Predisposition  to  disease  greatly  alterable, 
•especially  by  dietetic  measures.     P.  57  :  Proportional  number 


TABLE    OF    CONTENTS.  xi. 

of  Phthisis  and  tubercular  diseases.  P.  58 :  Diseases  of 
circulation,  including  apoplexy.  "Old  age"  as  a  cause  of 
mortality.  P.  59  :  Cancer  as  a  cause.  Cancer  a  disease  of 
over  feeding.  P.  61  :  Mortality  from  diarrhoea  and  dysentery ; 
essentially  diseases  of  wrong  feeding.  Convulsions  ;  alse  due 
to  wrong  feeding.  Pp.  62-4 :  Influenza  and  the  zymotic 
diseases  ;  facts  regarding  ;  mortality  from  ;  causes.  Pp.  64-5 : 
Mortality  from  digestive  diseases;  probably  stated  much  too 
low.  Pp.  65-7  :  Diseases  of  the  nervous  system.  Dr.  Dewey 
on  physiology  of  nervous  system  in  fasting.  P.  68  ;  Suggestion 
that  all  these  diseases  may  be  in  great  part  caused  by  wrong 
alimentation. 

Pages  69-81  :  Chapteb  III. ,  Causes  of  Mortality  betweeii 
Five  and  Sixty-five  Years.  P.  69  :  From  32  to  40  per  cent,  of 
all  mortality  under  five  years  of  age.  P.  70 :  Opinion  of 
medical  officers  of  health  that  much  of  this  mortality  is  due  to 
improper  feeding ;  and  the  probability  that  this  cause  also  acts 
at  later  ages.  Pp.  70-1 :  From  22  to  24  per  cent,  of  all 
mortality  over  65  years  of  age.  Therefore  about  40  per  cent, 
of  the  total  mortality  occurs  between  five  and  65  years  of  age, 
or  the  active  ages  of  life.  Pp.  71-2  :  Tuberculosis  and  cancer 
the  most  potent  causes  of  death  at  these  ages.  Eheumatism 
and  gout  important  indirect  causes  of  death.  P.  72  :  Diseases 
of  circulation  with  apoplexy  the  next  most  numerous  cause  of 
death.  Nextly,  diseases  of  respiration.  P.  73  :  Fourthly, 
deaths  from  old  age.  But  "old  age"  before  60  or  65  a 
misnomer.  Fifthly,  zymotic  diseases.  P.  74  ;  Sixthly  and 
seventhly,  diseases  of  digestion  and  nervous  diseases.  Dietetic 
diseases,  in  Eegistrar- General's  terminology,  a  trifling  cause  of 
death.  But  it  includes  alcoholism,  which  is  evidently  stated 
much  too  low,  deaths  from  alcohol  being  frequently  set  down 
to  diseases  of  the  various  organs  which  alcohol  has  affected. 
P.  75  :  But  alcoholism,  though  an  important  cause  of  death, 
is  not  nearly  so  important  as  wrong  feeding.  Teetotallers 
well-meaning,  but  wrong  in  attributing  many  diseases  to 
alcoholism  which  are  not  due  to  it,  but  frequently  occur  among 


xii.  TABLE    OF    CONTENTS. 

teetotallers.  P.  76 :  "What  the  teetotallers  have  proved. 
P.  77  :  Constipation  far  oftener  caused  by  bad  food  habits 
than  by  alcohol.  Pp.  77-8  :  Modus  operandi  in  which  this 
cause  acts.  Hov?  to  cure  constipation.  P.  78  :  Skin  diseases 
frequently  caused  by  wrong  food  habits.  P.  79  :  Many 
teetotallers  die  too  early  from  taking  too  many  meals.  Pp. 
80-1  :  Account  of  two  brothers,  one  a  teetotaller  and  the  other 
a  drunkard,  who  yet  lived  the  longer  of  the  two. 

Pages  82-125:  Chapter  IV.,  The  Causes  of  Disease. 
Three :  The  Proximate  (swelling  and  shrinking),  the  Exciting, 
and  the  Predisposing  Causes.  Pp.  82-83  :  Organised  bodies 
occupy  always  probably  about  the  same  amount  of  space,  this 
being  probably  due  to  the  large  quantity  of  water  they 
contain.  P.  84 :  The  proximate  causes  are  not  so  much 
causes  as  states.  Swelling  and  shrinking  always  precede  and 
follow  one  another  ;  yet  do  not  cause  one  another.  Difference 
between  causation  and  invariable  succession.  P.  85 :  Con- 
traction of  longitudinal  elements  causes  contraction  of 
transverse  and  vice  versa.  P.  86  :  This  causes  the  confusion 
of  supposing  that  contraction  causes  dilatation,  and  dilatation, 
contraction,  and  has  led  to  opposition  in  the  practice  of 
doctors.  P.  87 :  The  exciting  causes.  P.  88 :  Difficult  to 
separate  the  exciting  from  the  predisp'^sing  causes.  Attempt 
to  do  so  by  the  writer.  P.  88  :  Predisposing  causes  are  mostly 
the  relations  of  the  body  to  air,  food,  exercises,  heredity,  and 
anxiety.  Influence  of  heredity  in  disease  greatly  exaggerated. 
Organisation  generally  inherited  ;  disease  rarely.  The  relations 
of  the  body  to  food  far  the  most  important  predisposing  cause 
of  disease.  This  the  main  thesis  of  present  essay.  Pp.  88-9  : 
Analysis  of  this  thesis.  Ancient  divisions  of  treatment  of 
disease.  P.  90 :  How  greatly  improper  food  habits  pre- 
ponderate over  other  causes  of  disease.  Pp.  91-100  :  Discussion 
of  terms  acute,  chronic,  long,  short,  sub-acute,  and  mild,  as 
applied  to  diseases.  Acute  and  chronic  are  not  logical 
opposites.  Acute  the  opposite  of  mild,  not  of  chronic. 
Pp.    92-3 :    Retrograde    proposal    of    Asclepiades   of    Prusa. 


TABLE    OF   CONTENTS.  xiii. 

Position  and  views  of  Hippocrates.  P.  93 :  Definition  of 
chronic.  P.  94 :  Eemittent  and  intermittent.  Pp.  95-6 : 
Cause  of  intermission  and  alternation  in  disease  connected 
with  the  manner  of  the  earth's  rotation  and  behaviour  to  the 
sun.  P.  97  :  Life  may  behave  differently  on  other  planets 
behaving  differently  to  the  sun.  Pp.  97-100  :  Definitions  of 
short  diseases,  of  rather  short,  of  very  short,  acute,  per-acute, 
sub-acute.  P.  98  :  Possible  anticipation  of  germ  theory  of 
disease  by  Asclepiades  of  Prusa.  Pp.  99-100 :  Views  of 
Hippocrates.  P.  101  :  Evidence  to  be  adduced  for  view  that 
wrong  feeding  is  the  chief  cause  of  disease :  threefold,  (1) 
Disease  best  treated  by  alteration  of  diet ;  (2)  Health  endures 
so  long  (chiefly)  as  proper  feeding  resorted  to  ;  and  (3)  Return 
to  wrong  feeding  re-induces  disease.  P.  102  :  Even  the  fevers 
offer  no  exception  to  this  statement,  but  more  difficult  to  prove 
the  thesis,  because  fevers  usually  occur  but  once  in  hfe. 
Definition  of  fever  and  inflammation,  and,  p.  103  :  Specific 
inflammation.  Simple  inflammations  may  in  the  future  be 
shewn  to  be  associated  with  growth  of  micro-organisms  in 
blood  and  tissues.  P.  104  :  Why  so  difficult  to  prove  that 
recurrence  to  wrong  food  habits  re-induces  fever.  But  influenza, 
though  a  fever,  frequently  recurs.  Pp.  104-5 :  Cure  and 
prevention  of  colds,  and  recurring  influenza  in  a  man  38  years 
of  age.  Pp.  106-7  :  Cure  and  prevention  of  recurring  colds, 
and  malaria  lasting  30  years,  by  alteration  in  diet.  Failure  of 
quinine  to  cure  malaria.  P.  108  :  Law  of  constant  causes 
inducing  periodic  or  intermittent  effects.  Pp.  109-10  :  Purther 
remarks  on  the  case  shewing  that  wrong  feeding  was  the  chief 
cause  of  the  illness,  which  was  nevertheless  attributed  to 
residence  in  the  tropical  climate.  P.  110  :  Although  the  same 
fever  does  not  generally  recur,  another  one  not  infi-equently 
occurs  from  the  same  predisposing  causes.  Pp.  111-3  : 
Incidence  and  causation  of  fevers.  Fevers  have  increased 
slightly  La  last  ten  years  in  spite  of  "sanitation."  Total 
reduction  ia  fifty  years  only  50  per  cent.  Influenza  has  come 
to  stay,  at  least  for  a  time.     We  infer,   therefore,  that  a  main 


iiv-  TABLE    OF   CONTENTS. 

part   of    the   causation  of   fevers   has   been   overlooked,    and 
suggest  that  it  is  improper  food  habits,  and  in  particular  too 
many  meals.     P.  114 :  Even  paupers  in  workhouses  are  fed 
too  often.     Changes  of  doubtful  health  value  made  in  the  fare 
of   the  men   of    the   Eoyal   Navy.     P.    115:    Experience   of 
soldiers  in   Boer  War,  eating  (practically)  once   a   day.     De 
Quincey's  statement  about  Eoman  soldiers.     Food  customs  of 
imperial  Eome   in  second  century:    Celsus  on.     Pp.    116-7: 
Alterations  in  food  customs  according  to  Athenaeus,   increase 
from  one  or  two  to  four  or  five  meals.      Recommendation   of 
no  breakfast  plan  2350  years  ago.     Pp.   117-20:    Spread  of 
luxury  foreruns  decay.     Comparison  between  imperial  Rome 
and  modern  London.     Pp.    120-5  :  Fevers  alleged  to  be  due 
to  famine.     Often  occasioTied  no  doubt  by  famine,  but  really 
caused    by    previous   over-feeding.     Famine    ought   to   cause 
simple  attenuation  without  fever.     When  crops  fail  in  famine, 
however,  they  are  both  short  and  bad.     Diseased  potato  and 
diseased   rice    cause    respectively    famine    fever    and    plague. 
P.  123  :  Comparison  between  alcoholic  and  over-fed  person. 
Pp.  124-5  :   Fevers,   falling  chiefly  on   young  lives  which  do 
not  take  alcohol,  are  not  generally  caused  by  alcohol,  although 
in  more  advanced  hfe  they  sometimes  are. 

Pages  126-76  :  Chapteb  V.,  The  Circulation  of  the  Blood 
and  of  the  Lymph.  P.  126:  Less  change  than  is  generally 
supposed  has  been  introduced  into  medical  practice  by  the 
discovery  of  the  circulation  of  the  blood.  The  circulation  of 
the  lymph  has  hardly  been  made  use  of  at  all.  P.  127  : 
Ancients  thought  arteries  contained  air.  The  wind  pipe  they 
called  arteria  aspera.  It  divides  like  an  artery.  The  best 
ancient  physicians  had  a  good  general  grasp  of  the  subject  of 
medicine.  Pp.  128-9:  Local  diseases  are  mostly  local 
expressions  of  general  states,  and  are  therefore  generally 
best  treated  by  treating  the  whole  organism.  P.  130  :  If  this 
is  not  done,  other  and  worse  diseases  may  follow.  Pp.  130-1 : 
Ancient  physicians  felt  the  pulse,  although  they  did  not 
understand  the  circulation  of  the  blood.     Pp.  131-3  :   Views 


TABLE   OF   CONTENTS.  xv. 

of  the  medi£eval  philosophers  on  this  subject.     MultipHcation 
of   spirits.      Pp.     133-6 :    Different    views    of    the    relations 
between  structure  and  function.     The   assumption  by  modern 
science  that  structure  determines  function  by  no  means  proved. 
Pp.  136-8  :  Effects  of  the  state  of  the  blood  on  the  state  of 
parts  of  the  body.     Affection  of  two  organs  may  be  accounted 
for  by  the  state  of  the  blood,   which  is  common  to  both,   as 
well   as   by   the   influence   of    one    organ   on   another.     The 
influence  of  this  view  on  the  position  of  specialists.     P.    139  : 
Influence  of  the  discovery  of  the  circulation  of  the  blood  on 
blood-letting.      But   blood-letting   was   given  up  for   reasons 
independent  of  the  discovery.     Pp.  140-2  :  Three  great  facts 
known  to  the    ancient  physicians,  hundreds  of    years   before 
modern  science  had  been  evolved.     P.  142  :  Analogy  between 
study  of  a  machine  and  of  human  organism.     If  we  under- 
stand the  machine  it  is  unimportant  where  we  commence  to 
study  it;   but  more  convenient  to  do  so  in  some  ways  than 
others.    P.  141  •-   The  most  convenient  way  to  study  the  human 
machine  is  to  begin  with  the  digestive  processes,  because  these 
make  the  blood.     Mastication   and  insalivation.     Pp.  144-5  : 
Four   or  five   divisions   of    food   stuffs  suggested   by  Liebig. 
P.    145  :    Insalivation  converts  starch  into  glucose  or  grape 
sugar.     Pp.  146-7  :  Function  of  gastric  juice  or  gastric  acid  to 
digest  nitrogenous  foods.     Why  we  should  not  eat  to  satiety. 
Futility  of  taking  half  an  hour's  rest  after  food.     If  three  or 
four  hours'  rest  is  required,  we  have  eaten  too  much.      Why 
we  should  eat   slowly.     P.   148  :  Chymification.     P.   149-51 : 
Action    of    pancreatic    and   biliary   secretions.     Lacteals  and 
thoracic    duct.       Effects    of     respiration    when   digestion   is 
healthy  and  when  it  is  unhealthy.     Connection  of  respiratory 
diseases    with    digestion.     Pp.    151-3:     Connection    between 
unhealthy   digestion    and    the   occurrence   of   local   diseases. 
Pp.  153-5  :  Portal  circulation  and  importance  of  the  liver  in 
the  digestive  processes.     The  liver  the  largest  digestive  viscus. 
In  the  rabbit  it  contains  30  per  cent,  of  the  blood.     Liver  has 
a  very  free  blood  supply,  and  differs  very  much  in  its  weight 


xvi.  TABLE   OF   CONTENTS. 

and  size  at  some  times  from  what  it  does  at  others. 
P.  155-62:  Facts  regarding  the  distribution  of  blood  in  the 
body  of  a  rabbit  and  (perhaps)  also  of  man.  About  30  per 
cent,  of  blood  in  muscles.  Significance  of  this.  Much  blood 
required  for  muscular  work,  and  therefore  much  food.  Only 
about  22  per  cent,  of  blood  in  the  organs  of  the  circulation 
and  respiration  (heart,  blood-vessels,  and  lungs)  together. 
Therefore  less  in  these  than  in  the  muscles,  or  even  the  liver. 
Only  a  comparatively  small  amount  of  blood  in  the  brain 
Significance  of  this.  Brain  must  not  be  overcharged 
with  blood.  Therefore,  brain- workers  {i.e,,  townsmen)  do 
not  require  a  large  amount  of  food.  Circulation  in  the 
brain,  synchronous,  not  with  pulsation  of  heart,  but 
with  respiration.  Termination  of  brain  arteries  in  end 
arteries,  not  by  anastomosis.  Significance  of  this.  Connection 
between  "plain  living  and  high  thinking."  The  brain  seems 
to  act  rather  through  its  lymph  circulation  than  through  its 
blood  circulation.  But  brain-lymph  or  fluid  of  ventricles  (and 
in  nerve  sheaths)  probably  secreted  from  blood  vessels  in  choroid 
plexuses.  Animal  spirits  a  physical  fluid,  not  a  metaphysical 
conception,  originally.  Pp.  162-6  :  The  animal  spirits  or  fluid 
of  the  ventricles  belongs  to  the  same  class  as  the  lymph,  which 
is  secreted  to  the  extent  of  30  or  40  pints  (it  is  believed)  from 
the  blood.  The  lymph  is  the  watery  part  of  the  blood,  with 
fine  particles ;  and  the  animal  spirits  are  a  finer,  subtler  form 
of  lymph.  Lymph  is  separated  from  the  blood  in  the  lymph 
spaces  in  the  connective  tissue,  and  is  collected  and  elaborated 
in  lymph  vessels  and  lymph  glands.  The  capillary  vessels  lie 
between  arteries  and  veins.  Definition  of  arteries  and  veins. 
No  lymph  circulation  in  the  invertebrata.  The  lymph 
circulation  is  an  economical  provision  by  which  the  blood  parts 
to  the  tissues  with  any  nutrient  materials  not  used  up  by 
previous  circulation  in  the  tissues.  Lymph  comes  from  the 
blood  and  goes  back  again  into  it,  along  ynth  the  chyle  from 
the  digestive  tract.  Its  purpose,  therefore,  is  obviously 
nutritional.     Connective  tissues  are  in  layers,  which  separate 


TABLE    OF  CONTENTS.  xvii. 

from  one  another  when  the  mterspaces  are  filled  with  lymph. 
Pp.  166-170 :  Effects  of  too  frequent  feeding  on  lymph 
formation.  Too  much  blood  formed  and  too  much  lymph 
secreted.  Lymph  spaces,  lymph  ducts,  and  lymph  glands 
over  filled.  The  consequences  are,  tired  because  overloaded 
muscle  sheaths,  nerve  sheaths  and  bone  coverings,  and  also 
engorgement  of  lymph  glands,  and  even  suppuration  of  them, 
knovni  as  strumous  or  scrophulous  glands,  often  seen  in  the 
necks  of  children  and  young  persons.  Or  pleurisy,  or  white 
swellings  of  joints.  P.  170  :  These  suppurations  generally 
associated  with  growth  of  tubercle  bacilli.  P.  171  :  But  this 
means  rather  engorgement  with  lymph  from  engorgement  with 
blood,  from  excess  of  food,  than  deUcacy  of  constitution.  No 
doubt  the  digestive  powers  have  been  exceeded.  This  process 
may  not  indeed  create  the  bacillus,  but  it  attracts  it.  P.  172  : 
The  tubercle  bacillus  may  be  lying  dormant  in  the  body,  or  it 
may  be  ingested  with  the  food  immediately  or  more  remotely. 
P.  172-5  :  Analogy  from  manuring  ground  in  agriculture  to 
make  crops  grow  which  either  did  not  grow  before  or  did  not 
thrive  before,  although  the  manure  did  not  contain  the  seed 
which  springs  up.  Relation  between  organism  and  environ- 
ment, plain  and  obvious,  although  it  may  not  be  possible  for 
us  to  say  which  was  first. 

Pages  176-219  :  Chapter  VI.,  The  Paradoxes  of  Medicine. 
Pp.  176-7 :  Are  there  any  pathognomic  signs  of  under- 
feeding ?  A  much  more  difficult  question  than  might  have 
been  supposed,  because  thinness  and  wasting  and  inactivity  of 
function  may  be,  and  often  are,  marks  of  over-feeding  as  well 
as  of  underfeeding.  P.  177 :  Mark  Twain's  description  of 
functions  of  starving  men.  They  were  constipated  and  sleep- 
less. Pp.  177-8  :  But  constipation  and  sleeplessness  are 
oftener  caused  by  over-feeding  than  by  under-feeding.  P.  179  : 
"Why  we  should  not  treat  constipation  by  purgatives.  P.  180  : 
No  cure  by  this  means.  P.  181  :  A  much  constipated  person 
cures  his  malady  in  a  year  by  restricting  his  diet  to  two 
meals    a    day.       Pp.    181-2  :   How    constipation    may    lead 


xviil  TABLE   OF   CONTENTS. 

to  obstruction  of  the  bowels  and  even  to  cancer.  P.  183  : 
The  law  of  hereditary  transmission  of  disease.  A  common 
fallacy  in  discussion  of.  Pp.  184-6  :  Probable  and  experi- 
mental evidence.  P.  186  :  All  functions  diminished  by  too 
much  stimulus,  especially  by  stimulus  of  too  much  food. 
P.  187 :  State  of  the  brain-vessels  in  sleep.  Pp.  187-9  : 
Proportion  between  nutrition  of  longitudinal  and  transverse 
elements  of  vessels  and  other  parts.  P.  189 :  How  to  cure 
sleeplessness.  P.  190 :  Why  sleeplessness  ought  not  to  be 
treated  by  hypnotics  ;  nor  any  long-continued  condition  by 
drugs  calculated  to  induce  the  opposite  condition.  P.  191  : 
Why  blood-letting  fails  to  cure,  and  has  been  on  the  whole 
given  up.  P.  192  :  Diseases  and  remedies,  dry  and  moist,  hot 
and  cold,  &c.  P.  193 :  These  divisions  fanciful,  and  yet 
founded  on  substantial  physiological  facts.  Pp.  193-4  :  Second 
paradox;  that  the  same  causes  induce  opposite  states.  P. 
195  :  How  Surrey  fowls  are  fattened  for  market.  Dr.  King 
Chambers  and  starvation  of  over-repletion.  Pp.  195-6  : 
Wasting  treated  by  restriction  of  the  diet.  Pp.  196-201  : 
Diet  of  over-feeding.  For  first  fortnight  is  a  diet  of  great 
restriction.  P.  197  :  Calorie  value  of.  P.  198 :  A  misnomer 
to  call  it  in  the  first  fortnight  a  diet  of  over  -  feeding. 
P.  199  :  Diet  of  over-feeding  after  first  fortnight.  Calorie 
value  of.  Pp.  200-2  :  May  lay  foundation  for  subsequent 
diseases.  Pp.  202-3  :  Specific  gravity  of  urine  in  general 
debility.  Pp.  204-5  :  How  patients  sometimes  gain  weight 
by  restricting  their  diet.  A  case.  P.  207  :  The  question, 
although  disputatious,  cannot  be  escaped.  Pp.  207-8 : 
A  great  law  in  physiology  and  in  medicine.  Views  of 
Greeks  and  Latins  on,  and  names  used  by  them,  for 
contraction  and  dilatation.  P.  208  :  Confusion  by  ancients 
of  property  and  function.  Confusion  of  Latins  in  use 
of  term  solutio.  P.  209 :  Eelation  of  longitudinal  and 
transverse  elements  of  body.  Contraction  of  longitudinal  is 
dilatation  of  transverse,  and  vice  versa.  Strictum  et  laxum  and 
absoiytio  et  solutio.      P.  210 :    Confusion   shewn   by   use   of 


TABLE   OF   CONTENTS.  xix. 

phrase — Strictures  et  solutionis  complexio,  instead  of  strictures 
et  solutionis  alternatio.  How  one  doctor  sometimes  advises 
treatment  exactly  the  reverse  of  that  recommended  by  his 
'Colleague.  P.  211 :  How  cold,  judiciously  appHed,  may 
counteract  the  effects  of  exposure  to  excessive  cold.  Double 
action  of  tonics  and  relaxants.  Actions  of  cold  and  of  alcohol. 
Pp.  211-12  :  Physiological  reasons  for  existence  of  rival 
schools  in  medicine.  Pp.  212-13  :  Effects  of  exposure  to  cold 
combated  by  appUcation  of  cold  in  acute  illness.  P.  213  : 
Effect  of  long-continued  exposure  to  moderate  cold;  and  of 
exposure  to  long-continued  and  moderate  over-feeding.  P. 
214 :  The  reactionary  effects  cause  only  sub-acute  or  even 
mild  (but  long)  illnesses,  P.  215 :  Deficiency  of  function, 
excess  of  function,  and  irregularity  of  function,  all  induced  by 
long-continued  irritation.  Pp.  215-16  :  Canon  of  treatment  in. 
Excess  of  food  far  the  commonest  irritation  ;  nextly,  improper 
relations  to  air ;  then,  to  exercises ;  then,  anxiety.  Pp. 
216-19  :  Analogy  of  action  of  irritation  of  too  much  desire  for 
food  acting  on  the  body  physiological,  to  irritation  of  too 
much  desire  for  gain  acting  on  the  body  commercial.  The 
one  causes  feverishness  and  depression ;  the  other  booms  and 
panics. 

Pages  220-264:  Chapter  YII.,  The  Two  Medical 
Paradoxes  {continued).  Pp.  220-1  :  Meaning  of  the  term 
disease.  P.  222  :  Difference  between  functional  alteration  and 
organic  disease.  They  shade  off  into  one  another  insensibly. 
P.  223  :  So  do  sanity  and  insanity.  P.  224 :  On  the  whole, 
disease  characterised  by  presence  of  exudation.  In  functional 
alteration,  no  exudation.  P.  225 :  Changes  of  function, 
however,  probably  imply  slight  changes  of  structure  even  if 
undiscoverable.  P.  226  :  Disease  usually  springs  fiom  mal- 
nutrition, which  is  generally  due  to  excess  of  food.  The  chief 
form  it  takes  is  congestion  of  connective  tissue.  Pp.  227-8  : 
Meaning  of  termination  His.  Bodily  organs  consist  of  three 
parts — the  parenchyma,  and  the  inner  and  outer  coverings  or 
ilemmata.       P.    229 ;     Connection     between     stimulus     and 


XX.  TABLE   OF  CONTENTS. 

function.      Propositions   concerning.      P.    230 :    Duration   of 
life  when  deprived  of  food  and  drink,  and  of   air.     P.    231 : 
Proof    of    proposition  that   food-supply  is  the  chief  cause  of 
illness.       Pp.    232-5 :     As    affecting    circulation ;    nutrition ; 
respiration ;  renal  action  ;  temperature  of  body ;  cerebration  ; 
skin   function.     P.    236 :    Three    propositions   regarding    the 
relation  of  food  to  function.     P.  237-41 :  Efifects  of  poverty. 
Even  the  poor  eat  too  much  and  too  often.     Effects  of  too 
much  food  mistaken  for  those  of  too  little.     The  charwoman  ; 
the   beggar's   baby.     Dr.    King   Chambers   and   starvation  of 
over-repletion.     Direct  and  indirect  starvation.     P.  241  :  Mr. 
Seebohm  Eowntree  and  poverty.     Poor  in  York  take  too  many 
meals.     Pp.  241-2  :   Excess  of  function  generally  treated  by 
restriction  of  diet.     Pp.  242-5  :   Cases  of  diabetes,  or  excess 
of    renal   functiou.     Pp.    245-9 :    Too   great  mentalisation  is 
often  insanity.     Cases  treated  by  restriction  of  the  diet.     Dr. 
Dewey's  case  where  an  insane  lady  fasted  for  45  days  and 
became  sane.     P.  247  :  A  case  known  to  the  writer  in  which 
insanity  was  caused  by  an  inordinate  love  of  sweets.     P.  248  : 
"What  taking  six  pints  of  milk  a  day  means.     P.  249  :  Defect 
of    function   also  to   be   treated   by  restriction  of   diet.     Pp. 
250-4 :    Slowness    of    circulation.       Cases   of.      Pp.    253-4 : 
Medical   experts   differ   in   opinion   from    one    another.      Pp. 
254-6  :  Attenuation  treated  by  restriction  of   diet.     Explana- 
tion of    the   treatment.      How   it   acts.      Pp.    256-8  :    Slow 
respiration  treated  by  restriction.    Pp.  258-9  :  Defect  of  renal 
function :    Pp.    259-262 :    Subnormal   temperature  treated  by 
restriction   of    diet.     Unwillingness  to  submit   to  treatment; 
yet  temperature  raised  after  fasting.     Pp.   262-4  :  Defective 
cerebration   treated   by  restriction  of   the  diet.      Eelation  of 
heredity    to    mental    disturbance.       Pp.    262-4 :    Effects    of 
anxiety. 

Pages  265-326 :  Chapter  VIII.,  The  Quantity  of  Food 
and  the  Number  of  Meals  required  by  Man.  P.  265 :  How 
much  food  is  required  to  make  and  enrich  the  blood  ?  P. 
266  :  Bodily  functions  must  be  neither  checked  nor  clogged. 


TABLE   OF   CONTENTS.  xxi. 

P.  257  :  The  no  breakfast  plan  suggested  by  Hippocrates,  the 
very  expression,  "  avapL(rTO<s,  being  used.  Pp.  268-9 : 
Effects  of  wealth  and  poverty,  indirect  and  direct  starvation. 
Pp.  270-1  :  A  mistake  to  gauge  the  amount  of  food  required 
by  the  quantity  of  the  egesta.  The  quantity  of  ash  is  pro- 
portional to  that  of  coal  consumed.  P.  271  :  Inquiries 
should  be  conducted  over  a  long  time,  and  should  have  relation 
to  presence  of  illness  among  men.  Pp.  272-3  :  Almost  all 
medical  authorities  agree  that  v^e  habitually  eat  too  much. 
Pp.  273-5 :  Experience  of  Oddfellows  shows  that  men  live 
longer  than  before,  but  are  oftener  ill.  Is  this  due  to  the 
increase  in  food  consumed  of  late  years  ?  Pp-  275-9  :  Food 
requirements  according  to  different  authorities  —  Eanke, 
Moleschott,  Voit,  Playfair,  Atwater,  &c.  P.  277 :  Calorie 
value  of  food.  Pp.  279-282  :  Eequirements  of  physiologists 
too  high  when  gauged  by  clinical  experience.  Pp.  282-3  :  Dr. 
Haig's  views.  P.  283  :  Experience  of  Cornaro.  Pp.  283-4  : 
And  of  Addison,  his  biographer.  How  we  say  and  do  not  do. 
P.  284  :  Food  ingestion  in  infirmaries  too  great.  Quantity  of 
bread.  Effects  of  too  much  food  in  causing  depression.  Pp. 
285-7  :  How  fasting  may  undo  depressing  effects  of  too  much 
food.  Pp.  287-8  :  Eight  ounces  of  mixed  food  is  a  subsistence 
diet  for  the  lightest  forms  of  work.  Impossible  to  use  4f  lbs. 
of  food  daily  in  any  circumstances  without  danger.  Pp. 
288-90 :  Eequirements  of  the  nursing-mother,  and  of  men  in 
the  Eoyal  Navy.  Pp.  290-1  :  Fasting  first  increases  and  then 
diminishes  the  numbers  of  the  blood  corpuscles.  How.  Pp. 
291-2  :  Accumulation  of  reserves  in  body,  and  over-accumula- 
tion. Pp.  292-4  :  The  English  soldiers  who  died  at  Aldershot 
after  eight  hours'  deprivation  of  food  did  not  die  of  starvation. 
What  they  probably  did  die  of.  Probable  unwisdom  of 
proposed  preventative.  P.  294 :  Moderation  the  only  rule ; 
attempt  to  define  moderation  in  food.  P.  295  :  Death 
attributed  to  almost  all  causes  but  the  real  one  of  over-feeding. 
P.  296  :  "What  the  Medical  Council  or  the  Municipal  Councils 
might  do.    Pp.  297-303  :  Length  of  time  required  for  digestion 


xxu.  TABLE   OF   CONTENTS, 

of  food  much  longer  than  commonly  supposed,  or  than  time 
required  by  St.  Martin's  stomach.  Time  differs  very  much 
in  different  occupations  and  circumstances.  Keasons  for 
recommending  dissiteism  and  even  monositeism.  Good  effects 
of  these  practices.  Pp.  303-4  :  Even  children  v^ell  fed  on  two 
meals  a  day.  A  child  fed  for  15  months  on  one  daily  meal 
increased  her  v^eight  10  lbs.  P.  304  :  Did  she  have  too  much 
food  ?  Pp.  304-7  :  Dr.  Haddon's  views  and  those  of  the 
physiologists.  A  closer  agreement  ought  to  be  possible.  P. 
308 :  The  duty  of  medical  adviser  ends  when  he  has  declared 
the  law.  Pp.  308-11  :  Why  we  are  tired  some  hours  after 
eating.  Uric  acid,  &c.  Pp.  311-12  :  If  stimulants  are  taken 
should  they  be  taken  with  food?  Pp.  312-4:  Why  we 
often  wake  tired  in  the  morning  ?  Why  do  we  sleep  too  little 
or  too  much,  or  irregularly  ?  P.  314 :  Initis.  Pp.  315-17  : 
Hysteria,  being  an  affection  of  connective  tissue,  may  be 
accompanied  by  effusion  of  serum  on  the  brain,  coma  and 
death.  Eelation  to  rheumatic  fever,  pleurisy,  synovitis,  &c. 
Pp.  317-18 :  Eecurring  headaches,  neuralgias,  &c.,  proper 
advice  for :  restrict  diet.  Pp.  318-20  :  A  case  so  treated  and 
cured  after  many  failures.  Eelation  to  insanity.  P.  321  : 
Severe  mutilating  operations  generally  unnecessary,  and  futile. 
Pp.  321-3  :  Poliosis.  Women  should  eat,  not  little  and  often, 
but  little  and  seldom,  if  they  wish  to  become  more  resistant, 
and  get  rid  of  peliosis.  P.  323-6 :  General  conclusions  as  to 
quantities  of  food  and  time  for  taking  it.  An  ounce  of  mixed 
diet  daily  for  every  10  lbs.  of  body  weight  required  by  the 
townsman,  who  works  his  brain  rather  than  his  muscles. 
Salisbury  diet.  Views  of  Mrs.  Eichards,  and  Forster  of 
Munich.  Persons  should  never  eat  oftener  than  thrice  daily, 
and  most  persons  would  be  better  to  do  so  twice.  Two  to 
three  pints  of  water  required  daily. 

Pages  327-51  :  Chapteb  IX.,  Heredity  in  Disease. 
P.  327  :  Frequency  of  transmission  of  disease  greatly 
exaggerated.  Pp.  327-8 :  Case  reported  by  distinguished 
medical  writer  does  not  prove  his  suggestion  at  all.     P.  329 : 


TABLE   OF   CONTENTS.  xxiii. 

Organisation  transmitted.  Disease  not,  or  very  seldom.  Law 
of  transmission.  Enquiry  into  causation  essential  to  under- 
standing of  the  law.  P.  330  :  Burden  of  proof  is  on  those 
who  allege  heredity  of  disease.  Experience  from  consumption 
in  British  Army.  A  narrow  chest  transmitted  generally; 
consumption  very  seldom.  P.  331 :  Cancer  may  run  in 
famiUes  because  different  generations  live  similarly  and  induce 
it.  P.  332  :  If  disease  is  transmitted  it  ought  to  appear  early 
in  life.  But  the  cause  even  of  high  infant  mortality  is 
probably  environment  rather  than  inheritance.  Opinion  of 
medical  officers  of  health.  P.  333  :  Eesistance  a  quality  of 
organisation.  Liability  to  disease  different  from  subjection  to 
it.  P.  334 :  Predisposition  is  inverse  resistance.  P.  335  : 
If  the  subjection  to  infectious  disease  is  in  our  own  hands, 
we  should  be  ashamed  to  take  influenza,  and  we  should 
even  feel  it  a  disgrace  to  take  influenza  with  pneumonia, 
since  in  this  case  we  shall  almost  certainly  for  a  long 
time  previously  have  over-indulged  our  appetite.  P.  336  : 
Anxiety  a  contributory  cause,  and  very  occasionally,  perhaps 
the  chief  cause  of  disease;  but  such  anxiety  would  have 
to  be  very  great  and  very  unusual.  P.  337  :  Freedom 
from  disease  rather  dependent  on  self-government  than 
on  fate  or  ancestors.  Pp.  337-42  :  Constitution ;  diathesis ; 
atavism  or  heredity.  Suggested  definitions  of  these  terms. 
P.  338  ;  Constitution  always  changing.  Environment  is 
the  sum  of  the  circumstances  acting  on  the  constitution. 
P.  339  :  How  we  modify  our  environment.  Constitution  and 
environment  act  and  react  on  one  another.  P.  340  :  Heredity 
or  atavism  is  fixed  and  unchangeable.  P.  341 :  Physical  life, 
like  spiritual  life,  is  the  play  of  the  changing  on  the  fixed,  of 
the  temporal  on  the  eternal.  P.  341 :  Definition  of  diathesis. 
Pp.  342-5  ;  Ancient  views  on  transmission.  Organisation  and 
disease  mixed  up  and  confused.  P.  343  :  What  is  transmitted 
in  epilepsy  ;  unstable  nervous  organisation,  and  not  disease ; 
and  what  is  transmitted  in  other  diseases.  P.  344  :  Is  special 
susceptibility   to    take   infectious    fevers    transmitted  ?      No. 


xxiv.  TABLE    OF   CONTENTS. 

Kesistance  varies,  no  doubt ;  but  susceptibility  depends  mainly 
on  management.  P.  345 :  How  Hippocrates  anticipated  the 
pan-genesis  of  Darwin.  Pp.  346-7  :  Appalling  case  of  trans- 
mission of  drunkard's  liver.  But  this  very  exceptional.  If 
common,  humanity  could  not  survive.  Pp.  347-8  :  Difficulty 
of  distinguishing  organisation  from  disease.  Of  the  same 
kind  as  that  of  distinguishing  any  contraries,  as,  e.g.,  day 
from  night.  A  difficulty  more  theoretical  than  practical.  Pp. 
348-51  :  Parents  not  likely  to  transmit  to  children  diseases 
they  did  not  themselves  manifest  till  many  years  after  birth  of 
children. 

Pp.  352-80 :  Chapter  X.  The  Feeding  of  Children. 
P.  352  :  The  principle  of  moderation  in  food  applicable  to 
children  also.  Children,  like  adults,  are  often  fed  both  too 
often  and  too  much.  Anxiety  not  a  cause  of  children's 
ailments,  or  hardly  so.  P.  353  :  Overfeeding  the  chief  cause 
of  children's  digestive  troubles,  colds  and  fevers.  P.  354  : 
Milk  the  proper  food  of  infancy.  Comparison  between  human 
and  bovine  milk  P.  365  :  How  to  replace  the  one  by  the 
other.  Strength  of  food  should  advance  with  age.  P.  356  : 
Capacity  of  stomach  at  different  ages.  Pp.  356-7  :  Ancient 
and  modem  practices  as  to  feeding  infants.  Number  of  meals 
proper  to  them.  Eelation  of  feeding  to  growth.  Increase  of 
growth  in  first  year  of  life  amounts  to  about  half  an  ounce  a 
day ;  but  extra  food  given  is  usually  much  beyond  what  is 
proper.  P.  359  :  Illness  among  children  far  oftener  caused 
by  too  much  food  than  by  too  little.  Alternation  of  neglect 
and  over-indulgence.  Pp.  360-1  :  Growth  of  children  from 
second  to  fifth  year ;  intermittent  rather  than  continuous. 
Professor  Holt  on  loss  of  weight  in  children's  illnesses.  Even 
the  beggar's  baby  is  too  often  fed  and  too  much.  Pp.  362-3  r 
Increase  of  weight  from  five  to  sixteen  years;  from  4  to 
6  lbs.  a  year ;  but  the  extra  food  given  to  growing  children 
is  usually  far  beyond  their  requirements.  Pp.  363-5  :  The 
same  causes  act  on  expectant  mother  and  frequently  make  her 
ill,  though  illness  is  attributed  to  many  other  causes.     P.  365  : 


TABLE   OF   CONTENTS.  xxv. 

Feeding  of  children  determines  the  healthy  growth  of 
nervous  system  as  well  as  other  parts  of  the  body.  Interest 
of  this.  P.  366  :  Necessity  of  early  inculcation  of  self- 
restraint.  P.  367  :  Effects  of  feeding  on  constitution  of  fluids 
of  brain-ventricles  or  the  animal  spirits  of  the  ancient  writers. 
Why  children's  breath  is  often  offensive  in  early  morning.  P. 
368 :  Feeding  of  school  children.  Three  daily  meals,  at 
most,  sufficient.  P.  369 :  No  solid  food  should  be  taken  at 
the  forenoon  interval.  Fevers  and  infection.  Effects  of 
infection  greatly  exaggerated.  P.  370 :  If  children  develope 
fevers  through  very  slight  infection,  their  state  rather  than  the 
infection  is  the  cause.  Over-fed  body,  and  over-manured  soil, 
grow  fever  and  weeds  respectively.  Pp.  370-2  :  Details  of  a 
case  where  a  delicate  child  was  over-fed.  Dissiteism  recom- 
mended after  recovery.  Pp.  373-5  :  Difficulties  from  prejudice 
and  from  wrong  use  of  words.  The  strengthening  and  the 
lowering  treatment,  and  the  competition  between  Mr.  Pilgrim 
and  Mr.  Pratt  in  Milby.  A  diet  of  port  wine  and  bark  is 
really  a  very  restricted  diet.  What  purging,  blistering  and 
bleeding  can  do  and  what  they  can  not  do.  What  is 
a  stimulating  diet  ?  P.  376 :  Signs  of  health  in  children. 
Dr.  Dewey's  suggestions  for  feeding  school  children.  Writer's 
suggestions.  P.  378  :  Trissiteism  not  unsuitable  ;  but  writer 
prefers  dissiteism.  P.  379 :  But  dissiteism  might  at  least 
be  adopted  from  21  or  25  to  55  ;  after  which  monositeism 
is  safest.  Pp.  379-80  :  Life  passes  insensibly  from  infancy 
to  childhood,  adolescence,  maturity  and  old  age,  which  last 
bears  abstinence  well  and  over-feeding  badly. 

Pages  381-434 :  Chapteb  XI.  On  Cancer.  P.  381  : 
Cancer  only  one  of  many  diseases  which  are  one  in  causation, 
treatment  and  prevention.  P.  382  :  Cancer,  if  incurable, 
easily  preventible  theoretically.  Panic  to  be  deprecated. 
Cancer  not  one  of  the  largest  causes  of  mortality.  Pp.  383-7  : 
Not  necessary  to  raise  a  million  pounds  sterling  in  order  to 
reduce  the  incidence  of  cancer  mortality.  Even  if  cancer 
proved    to    be    due    to    micro-organisms,    the    problem    of 


xxvi.  TABLE   OF   CONTENTS. 

prevention  would  still  be  the  same.  Laboratory  results  of 
diagnostic  and  of  classification  value ;  but  for  treatment  ?  or 
prevention  ?  almost  none.  P.  384  :  Analogy  from  diphtheria. 
P.  385 :  Growth  of  a  micro-organism  comparatively  unim- 
portant ;  while  the  state  of  body  that  harbours  it  is  of  the 
utmost  consequence.  P.  386-7  :  The  true  answer  to  inquiry 
into  causation,  and,  therefore,  of  prevention  of  cancer,  is  to 
be  got  from  physiology  and  bed-side  observation.  Let  us  use 
our  eyes  first  and  the  microscope  afterwards.  Pp.  387-8  :  Way 
in  which  a  million  pounds  sterling  might  be  used,  so  as  to 
settle  the  causes  of  cancer.  Would  the  millionaires  agree? 
Pp.  388-9:  The  King  and  cancer.  P.  389:  Predisposing 
causes  of  cancer  obvious.  P.  390 :  Cure  practically 
impossible ;  prevention  easy.  P.  391  :  Increase  of  mortality 
from  cancer  on  the  whole  real.  P.  392  :  Complete  prevention 
not  to  be  expected ;  but ^raciicaZ  prevention.  P.  393  :  "Once 
cancerous  always  cancerous."  Operation  alone  a  futile  means 
of  cure.  Added  to  altered  mode  of  living,  might  be  hopeful. 
Pp.  394-6  :  Effects  of  causes  slowly  modifying  the  organism 
during  many  years  cannot  be  overcome  by  operation  alone.  It  is 
impossible.  Effects  of  recurring  devastation  cannot  be  undone ; 
but  appreciation  of  their  causes  may  prevent  their  recurrence. 
P.  396  :  Definition  of  cancer  and  sarcoma.  P.  397  :  They 
are  hypertrophies  or  overgrowths.  What  is  by  far  the  most 
likely  cause  of  overgrowth  ?  Over-nutrition,  that  is,  over- 
feeding. P.  398:  "Infection  from  without."  Food  intro- 
duced from  without  alters  the  body  so  as  to  render  it 
susceptible.  Pp.  398-9 :  Importance  of  connective-tissue- 
congestion.  Eelation  therefore  of  cancer  to  rheumatism  or 
initis.  Disease  being  one,  initis  is  the  one.  Restricting  the 
diet  will  reUeve  fatigue  of  initis,  and  prevent  the  onset  of 
cancer.  Pp.  400-1 :  How  materials  enter  the  blood.  Four 
ways.  Is  cancer  inhaled  or  breathed  in  ?  Not  likely,  though 
not  impossible.  Reasons  for  thinking  so.  Pp.  402-5 :  Is 
cancer  introduced  through  cracks  in  the  skin  or  mucous 
surfaces  ?      Not    impossible,    but    not    likely.      Lip    cancer. 


TABLE   OF   CONTENTS.  xxvii. 

P.  403  :  Does  smoking  introduce  it  ?  Irritates,  but  does  not 
introduce.  Cancer  due  to  a  blow.  The  injury  does  not 
introduce  it.  Cannot  do  so,  any  more  than  bicycle  injury  can 
introduce  gout.  P.  404  :  Occasion  and  cause.  Inoculation 
of  cancer.  Not  a  practical  risk,  though  not  theoretically 
impossible.  Pp.  405-10  :  Is  cancer  transmitted  from 
ancestors  ?  No.  P.  406  :  Cancer  very  uncommon  in 
childhood.  If  appearing  (as  it  does)  later  in  life,  far  more 
likely  to  be  acquired.  Do  parents  transmit  what  they  have 
not  themselves  got  ?  P.  407 :  Predisposition :  what  ? 
Organisation  and  disease.  P.  408  :  Propositions  about 
transmission  of  disease.  P.  409  :  Facts  about  incidence  of 
cancer  in  childhood.  P.  410  :  and  later  life.  The  causes  of 
cancer,  whatever  they  are,  increase  as  age  advances.  Pp.  410- 
31.  Cancer  is  introduced  through  the  digestion.  "We  eat  it. 
P.  410  :  The  age  incidence  of  cancer  goes  to  prove  this  view. 
Wrong  alimentation  gains  power  as  age  advances.  In  early 
life  irritation  reacts  by  intolerance  into  fever  and  acute 
inflammation  ;  in  later  life  by  tolerance  into  depression,  and 
then  into  mild  and  slow  disease,  with  intercurrent  subacute  or 
acute  exacerbations.  P.  411 :  Irritation  and  tolerance,  with 
depression,  found  sometimes  even  in  childhood.  The 
depression  stage  is  the  best  time  to  treat  chronic  disease,  and 
80  to  prevent  the  onset  of  fatal  disease.  P.  412  :  How  cancer 
becomes  more  prevalent  as  age  advaDces.  P.  412  :  Cancer  in 
dogs  and  pigs.  P.  413  :  Why  cancer  affects  women  more 
than  men.  Habit  the  cause  rather  than  sex.  But  the 
preponderance  of  the  proportion  among  women  to  cancer,  as 
compared  with  men,  is  diminishing.  Why  ?  Because  the 
habits  of  the  sexes  are  approximating  in  character  to  one 
another.  Pp.  414-5  :  Comparison  of  habits  of  women  with 
those  of  men.  Pp.  416-7  :  Women  eat  oftener  than  men. 
The  kinds  of  food  they  like.  P.  417  :  Food  habits  of  boys  and 
girls  much  the  same  as  one  another.  Cause  of  frequent  illnesses 
of  domestic  servants.  Pp.  418-9 :  Comparison  between  food  and 
work-habits  of  men  and  women  continued.     P.  419 :  Indefinite 


xxviii.  TABLE   OF   CONTENTS. 

postponement  of  illness  is  equivalent  to  its  prevention. 
General  habits  of  to-day  deteriorate  health ;  but  bad  food 
habits  a  most  important  cause.  Pp.  420-3  :  Cases  of  cancer 
apparently  caused  by  too  frequent  feeding  (pollaki-siteism). 
Habits  affect  vs^ell-to-do  and  ill-to-do  women.  P.  423  :  Great 
increase  in  consumption  of  sugar.  Bread  and  jam,  a  whole- 
some food  once  a  day,  but  five  times  a  day  is  deadly.  P.  424  : 
Eegularity  of  life  good  ;  but  regularity  in  wrong-living  is 
deadly.  Pp.  424-6  :  Misery  a  contributory  cause  of  cancer. 
But  cancer  spares  neither  poor  nor  rich,  miserable  nor  happy. 
Effects  of  anxiety  on  men  and  women.  P.  426 :  Alleged 
influence  of  cancer  houses.  Fallacy  of  this  statement.  The 
food-habits  of  the  tenants  should  be  investigated.  P.  427  : 
Damp,  swampy  districts,  and  alcohol  may  sometimes  be 
contributory  causes.  Pp.  428-9  :  Cancer  might  easily  be 
reduced  and  prevented.  Increasing  weight  of  authority  that 
it  is  a  food-disease.  Pp.  429-30  :  Dr.  Braithwaite's  views  as 
to  excess  of  salt  being  a  cause  of  cancer.  P.  431  :  Mr. 
Giimpel's  criticism  and  view  supported  by  the  author.  Salt  in 
the  blood.  Pp.  432-4  :  Advice  as  to  means  of  preventing 
cancer,  the  same  as  that  intended  to  prevent  other  diseases. 
The  strength  and  the  weakness  of  this  view. 

Pages  435-522 :  Chapter  XII.  General  Observations ; 
and  Cases  illustrative  of  the  Causation  and  Cure  of  Disease 
by  Diet.  P.  436 :  Too  much  food  the  chief  cause  of 
disease.  A  knowledge  of  causes  necessary  for  prevention ; 
and  our  belief  in  alleged  causation  corroborated  by  ability 
to  prevent.  P.  437  :  Some  medical  advisers  will  probably 
always  be  necessary.  Pp.  438-9 :  Prophasiology  and 
etiology.  Prophasiology  a  part  of  etiology.  P.  440 :  A 
practical  question  more  than  a  theoretical  one.  Food  as  a 
cause  of  disease  much  greater  than  alcohol.  P.  441  :  Indiges- 
tion the  first  step  in  the  production  of  illness.  Pp.  441-2  : 
Two  great  lines  of  evolution  of  disease,  one  culminating  in 
cancer,  the  other  in  tuberculosis.  P.  442  :  Etymology  of 
scrofula.     P.  443 :  Two  definitions  of  tuberculosis  compared. 


TABLE   OF  CONTENTS.  xxix. 

Quite  impossible  morally,  and  almost  impossible  physically, 
*'  to  keep  away  from  infection."  Pp.  444-5  :  Causation  and 
cure  of  bronchitis  by  diet.  Pp.  445:6  :  Asthma  best  treated 
by  restriction  of  diet.  Medical  men  have  long  taught  this 
view.  Pp.  447-9 :  Temporary  confusion  in  writer's  mind 
between  poly-amylism  and  poly-siteism.  Pp.  449-52  :  History 
of  a  case  of  bronchitis.  Its  relation  to  rheumatism  or  initis 
and  varicosity  of  veins.  P.  452  :  Further  considerations  on 
this  case.  P.  453  :  Dissiteism  would  probably  have  been 
better  than  trissiteism  for  it.  Cure  of  repeated  broncho- 
pneumonia and  influenza  by  diet.  Pp.  453-4  :  Also  of  colds 
and  malarial  ague  by  the  same.  P.  454  :  Eemarkable  cure  of 
old  lady  of  72.  Dogma  :  Bronchitis  is  caused  by  excess  of 
food.  P.  455  :  Inference  from  this  dogma  :  Bronchitis  pre- 
ventible  by  diet  (between  five  and  65  years  of  age).  P.  456  : 
New  hope  for  humanity  from  this  dogma.  Pp.  456-7  :  Letter 
from  America  detailing  cure  of  asthma  by  diet.  P.  458  : 
Uses  of  exercises  for  the  body.  Quantity  of  fluid  required. 
Eecurrent  bronchitis  ending  in  fatal  pneumonia  caused  by 
wrong  dietary.  Teetotalism  did  not  save  the  patient.  Pp. 
460-1 :  Pneumonia  also  caused  by  wrong  dietary,  and  there- 
fore preventible  by  proper  dietary.  P.  462  :  Another  fatal  but 
probably  preventible  case.  P.  463  :  Medical  scientist  can  only 
declare  the  law.  Eheumatism  and  gout.  Etymology  of 
rheumatism.  P.  464  :  Eheumatism  is  congestion  of  connective 
tissue.  P.  465 :  Clinical  relations  of  rheumatism.  Best 
treatment  of.  P.  466  :  Suggested  alteration  of  name  to  initis. 
Etymology  of  gout.  P.  467  :  How  we  eat  rheumatism  and 
gout.  Eestriction  of  diet  often  cures  rheumatism.  Pp. 
467-8 :  A  case.  Pp.  468-71 :  Another  case,  hereditary  in 
conventional  sense,  but  not  really  so.  P.  371  :  Anasmia 
or  triphthsemia  or  catatribaemia,  due  to  over-feeding,  and 
tractable  by  restriction  of  diet.  P.  472 :  Many  wasting 
diseases  should  be  treated  by  restriction.  Law  of  con- 
stant causation  and  intermittent  or  periodic  effects.  Or, 
P.   473  :    Causes   acting   at   short    intervals    produce    effects 


XXX.  TABLE   OF   CONTENTS. 

at  longer  intervals.  P.  473 :  Canon  of  treatment  arising 
from  this  law.  The  ancient  view  sound,  that  we  should 
treat  periodic  affections  in  the  intervals  rather  than  in 
the  attacks.  P.  474 :  Periodic  aflfections  are  on  the  way 
to  becoming  chronic.  But  chronic  illness  is  not  always 
equally  present.  What  recurring  headaches  lead  to. 
Pp.  474-5  :  A  case.  How  it  might  have  been  better  treated. 
P.  476  :  Other  causes,  like  damp,  &c. ,  may  be  contributory  to 
rheumatism.  Pp.  476-7 :  Connection  between  causes  of 
ovarian  tumour  and  bilious  attacks.  A  patient  advised  to 
become  monositeous  after  removal  of  an  ovarian  tumour. 
This  the  best  means  to  prevent  future  illness.  P.  478 : 
Futility  of  treating  periodic  illnesses  by  palliatives.  Pp.  478-80  : 
Case  of  cure  of  recurring  illness  without  the  intervention  of 
the  medical  expert.  Pp.  480-2  :  Eecurring  affections  of  the 
skin,  as  erysipelas  of  the  face,  cured  by  restriction  of  diet. 
Eationale  of.  P.  482  :  Erysipelas  a  specific  inflammation, 
associated  with  growth  of  micro-organisms,  and  allied  to  the 
fevers.  Suggestion  therefore  that  the  fevers  also  are  to  be 
prevented  by  proper  diet.  P.  484  :  Too  great  redness  and  too 
great  pallour  of  the  skin.  Causes  of  Anaemia.  Overgrowth 
of  circular  fibres  of  vessels  in.  P.  485  :  Same  causes  which 
produce  redness  of  erysipelas  produce  pallour  of  anaemia. 
Also  constipation  and  diarrhoea.  P.  486 :  How  therefore  to 
be  treated.  Pp.  486-8 :  Case  of  Pruritus  ani.  Proof  of  its 
causation,  and  eflSciency  of  treatment.  Pp.  489-90  :  Is 
further  proof  possible  ?  Pp.  490-3  :  Sycosis  menti  or  tinea 
barbae,  tractable  by  diet.  Theory  of  treatment.  Significance 
of  existence  of  parasitic  diseases  and  of  fevers,  not  particular, 
but  general.  Pp.  493-4 :  Skin  function,  like  others,  may 
shew  excess,  defect,  or  irregularity.  Pp,  494-502  :  Ulceration 
due,  like  other  conditions,  to  two  opposite  causes,  starvation 
and  plethora.  P.  495  :  The  callous  ulcer  caused  by  over- 
feeding. P.  496  :  Good  effects  of  fasting  in  callous  ulcer. 
Treatment  of  ulceration  of  stomach.  P.  497  :  Of  scrofulous 
ulceration ;  juvenile  and  senile  cases.    Pp.  498-502  :  Ulceration, 


TABLE   OF   CONTENTS.  xxxi. 

probably  of  large  intestine,  cured  by  restriction  of  the  diet. 
Eationale  of  the  treatment.  Evidence  probable,  not 
demonstrative.  Pp.  502-4  :  Dilatation  of  the  pupils.  How 
caused.  Sometimes  accompanied  by  slow  pulse.  Can  often 
be  modified  by  restriction  of  diet.  Pp.  504-7  :  Epilepsy  and 
its  treatment.  Transverse  elements  of  pupils  are  irritated. 
P.  507 :  Defects  of  vision  and  dietary  causes.  P.  508  : 
Dilatation  of  pupils  often  an  important  sign  of  illness. 
Nature  gives  us  desires.  It  is  for  us  to  govern  them.  P.  509  : 
Only  a  few  seem  willing  to  attempt  this.  But  a  minority  of 
medical  men  in  every  generation  has  always  taught  it. 
Pp.  511-6 :  Writer's  view  illustrated  from  history  of  well 
known  literary  character.  The  cause  of  her  ailments  was  too 
many  meals.  Pp.  516-20 :  All  diseases  probably  more 
amenable  to  dietary  than  to  any  other  form  of  treatment. 
P.  520 :  Too  much  surgery.  P.  521  :  No  panacea  for  human 
suffering.     But  moderation  the  chief  means  to  diminish  it. 

Pp.  623-37  :  Chapter  XIII.  Exercises.  P.  523 :  Are 
exercises  necessary  to  health  ?  Opinions  of  authorities. 
P.  624 :  Exercises  cannot  undo  persistent  and  long-continued 
effects  of  over-feeding.  P.  626  :  Heavy  exercise  should  be 
entered  on  gradually.  Pp.  526-7 :  Women  and  exercises^ 
Three  drawbacks  in  the  lives  of  women.  Pp.  527-9  :  Exercises 
among  the  ancients.  Celsus.  Active  and  passive  exercises. 
Pp.  529-30  :  Baths  in  ancient  times.  P.  630  :  Sound  ancient 
view  as  to  relation  of  exercise  to  digestion.  Pp.  530  :  Kinds 
of  exercises.  P.  532  :  Effects  on  lymph- circulation.  Should 
not  be  overdone.  P.  633 ;  Well-balanced  mind  avoids 
extremes  of  rush  and  torpor.  Pp.  534-5 :  Some  publications 
on  exercises.  Pp.  636-7  :  Exercises  should  be  taken  when 
digestion  is  not  going  on.     Better  twice  than  once  a  day. 


INTRODUCTION. 


rj^EDICINE,  connected,  as  the  word  is,  with 
the  Latin  verb  mederi,  to  heal,  may  be 
defined  as  the  theory  and  art  of  managing  the  sick, 
of  restoring  them  to  health,  and  of  preventing  the 
occurrence  or  recurrence  of  illness.  It  is  evident 
that  the  last  branch  of  medicine  named,  that  which 
is  occupied  with  the  prevention  of  illness,  is  one  of 
late  growth ;  and,  as  a  historical  fact,  it  has  come 
into  existence  only  of  late  years.  I  am  not  aware 
that  the  idea  of  preventing  illness  entered  into  the 
minds  of  the  classic  Greek  and  Latin  writers  on 
medicine  at  all.  With  cure,  on  the  other  hand,  of 
diseases  which  had  already  arisen,  they  occupied 
themselves  greatly,  just  as  we  do  now.  In  the 
opinion  of  the  writer  of  this  essay,  very  little  has 
been  done  in  the  domain  of  the  prevention  of  illness 
and  of  disease,  compared  with  what  may  be  expected 
to  be  done  in  the  future,  and  with  what  may  be 
done  now.  Evidently,  before  preventive  medicine 
can  attain  any  great  measure  of  success,  we  must 
know  what  the  causes  of  disease  and  of  illness 
are.  To  treat  disease,  it  is  not  necessary  to  know 
much,  or,  in  fact,  almost  anything  of  its  causes. 
At  least,  long  before  it  occurs  to  us  to  inquire  as  to 
its  causes  we  adopt  almost  instinctively  a  method 
of  treatment,  and,  if  the  disease  is  at  aU  severe, 

A 


that    method   usually  involves   the  three  practical 
points  of*  putting   the   patient    at    rest    in  bed,  of 
giving  him  medicine  in  some  form  or  other,  and  of 
altering  his  diet,   since  we   seem   to  feel   that  we 
cannot    feed    him    in    sickness    as    he    has     been 
accustomed   to   be   fed  in  health.     Nature    herself 
indeed  points  the  way  to  us  in  this  matter,  for,  if 
the  patient  is  very  ill,  or  even  moderately  so,  he 
is  naturally  unable  to  be  up,  and  his  appetite  is 
generally  entirely  absent,  or  at  least  much  impaired. 
This  is  so  at  least  in  those  cases  of  illness  in  which 
feverishness  is  present,  that  is,  those  in  which  the 
pulse  is  quickened  and  the  temperature  is  elevated, 
as   in   fever,  and  inflammation,  and  severe  injury. 
But  if  after  a  time  it  occurs  to  us  that  perhaps  it 
might   have   been  possible   to   avoid  the  fever,  to 
prevent  the  inflammation,  or  to  escape  the  injury,  it 
is  plain  that  we  must  first  know  what  are  the  causes 
of  these  different  conditions  of  body  before  we  can 
offer  advice  as  to  how  they  may  be  prevented  in  the 
future  either  in  the  case  of  the  given  patient  or  of 
others.     As  to  the  last  named  condition,  that  of  the 
injury,  it  will  at  once  occur  to  every  one  that  to 
avoid  or  to  prevent  a  recurrence  of  that  will  offer 
the  simplest  case  of  the  application  of  preventive 
medicine,    since    it    is    comparatively   easy   to   see 
whether  knife,  or  industrial  tool,  or  warlike  arms,  or 
accidental    fall    have    caused   the   condition ;    and 
prevention  will  resolve  itself  therefore  into  the  one 
piece  of  advice  to  be  more  careful  in  the  future. 
As  to  the  fever  and  the  inflammation,  the  problem 


is  much  more  complicated,  and  it  is  more  com- 
plicated still  as  regards  the  occurrence  of  such  a 
condition  as  tumour-growth  ;  but  it  is  evident  that 
the  means  recommended  by  the  medical  adviser,  by 
the  adoption  of  which  these  evils  are  to  be  escaped, 
will  differ  according  to  the  view  which  he  takes  of 
their  causation.  In  point  of  fact,  as  regards  the 
incidence  of  fevers  only,  has  much  thought  been 
expended  on  their  causation,  while  even  as  to  this 
opinions  are  divided  into  two  great  classes,  one 
holding  with  the  modern  sanitarians  that  of  all  the 
causes  of  disease,  and  particularly  of  all  the  causes 
of  fever,  vitiation  of  air  is  far  the  most  important, 
while  the  other  holds,  as  Moses  did  at  Kibroth 
Hattaava,  that  improper  feeding  is  the  cause  of 
fevers,  and  that  if  the  Israelites  gathered  and  con- 
sumed quails  in  excess  for  two  days  and  a  night,  it 
was  no  wonder  that  plague  should  break  out  among 
them,  and  that  it  should  be  necessary  to  bury 
at  Kibroth  Hattaava  those  of  them  that  lusted. 
Evidently  the  advice  calculated  to  prevent  the 
outbreak  of  the  pestilence  that  stalketh  in  darkness 
or  of  the  destruction  that  wasteth  at  noon-day ; 
the  advice  given  as  to  how  we  are  to  prevent 
scarlet  fever  or  typhoid  or  influenza,  will  differ 
according  to  the  different  views  we  may  take  as  to 
the  causation  of  these  affections.  On  the  former 
view  much  attention  will  be  directed  to  the  opening 
of  windows  so  as  to  obtain  the  freest  ventilation, 
and  to  supplying  abundant  cubic  space  to  each 
person,  so  as  to  prevent  overcrowding;  on  the  latter 

A2 


we  shall  devote  much  attention  to  the  quantity  and 
quality  of  the  food  (and  drink)  taken,  and  to  the 
amount  of  time  that  should  elapse  between  each 
meal. 

As  a  preliminary  to  the  consideration  of  the 
question  whether  it  is  more  likely  that  bad  vitiated 
air  or  wrong  feeding  is  the  more  potent  cause  of  the 
incidence  of  fever,  let  us  consider  which  of  these 
two    great    sets    of    physiological    processes    most 
alters   a  man.      A   man    emits    as    much    carbonic 
acid  gas  through   his  respiration  as  would  suffice 
to    supply    about    half    a   pound    of    carbon    daily 
were    it    to    be    chemically    separated    from    the 
carbonic  acid  gas.     This  is   a   large   amount,   and 
bears   quite  a  considerable   proportion  to  his  body 
weight    of    say    140    lbs.,    or    about    •/    per    cent. 
But  if  he  takes  what  is  generally  considered  the 
quite  moderate  allowance  of  2  lbs.  of  food  daily,  it 
is  evident  that  he  consumes  his  own  weight  of  food 
in  70  days,  or  a  little  over  two  months  ;  while  if  he 
takes    3    lbs.    of   food  daily,    the   quantity   recom- 
mended  by  Dr.   King   Chambers   for   the   nursing 
mother,    he   consumes  his   own  weight  of  food    in 
46    days.       Some   physiologists    contemplate   with 
equanimity   the    consumption  of   5  lbs.    weight    of 
food  daily,  and  at  this  rate  a  man  would  eat  his 
own  weight  in  28  days.     I  hope  to  say  something 
later   regarding   the   very   extensive   quantities  of 
fluid  which  in  various  forms  pass  into  and  out  of 
the  blood  daily  ;  but,  referring  now  to  food  alone,  as 
distinguished  from  water,  I  think  I  am  justified  in 


saying  that  a  priori,  so  to  say,  and  on  the  general 
merits  of  the  question,  it  is  more  likely  that  a  man's 
body  should  be  modified  by  food  than  by  air.  Of 
course  there  are  many  other  changes  effected  by  the 
respiration  than  the  mere  emission  of  half  a  pound 
of  carbon  daily.  Other  organic  materials,  not  to 
mention  a  quite  considerable  amount  of  watery 
vapour,  are  given  forth  by  the  lungs,  but  the  total 
amount  of  change  in  the  body  effected  by  the 
respiration  is  very  much  less  than  the  amount 
effected  by  the  digestion  and  assimilation  of  food 
and  water  in  the  body.  Whoever,  therefore,  should 
argue  that  food  is  probably  a  greater  agent  in 
producing  health  or  disease  in  the  body  than  air, 
founds  his  opinion  on  substantial  facts  of  this  kind ; 
and,  at  any  rate,  no  inherent  improbability  attaches 
to  his  contention. 

As  to  other  affections  of  the  body  besides 
the  fevers,  the  inflanmiations,  for  instance,  and 
particularly  as  to  the  occurrence  of  tumour-growths, 
it  will  probably  be  admitted  that  scarcely  anyone 
thinks  of  methods  of  preventing  them,  almost  every 
one  tending  to  look  upon  these  conditions  as  part  of 
the  inevitable  order  of  Nature.  Let  us  hope  that 
another  view  will  project  itself  on  our  minds  before 
we  finish  our  consideration  of  the  subject,  so  that 
some  means  of  preventing  these  evils  that  now 
afflict  humanity  may  arise  before  our  imagination, 
and  offer  itself  to  our  practical  grasp.  At  present, 
however,  I  fear  it  must  be  admitted  that  any  one 
who  hints  that  perhaps  more  study  of  the  causes  of 


the  inflammations  and  tumour  growths  might  enable 
us  to  suggest  methods  by  which  they  might  be 
prevented,  and,  especially  if  in  order  to  this  end, 
he  suggests  that  it  is  necessary  to  exercise  a  certain 
amount  of  self-restraint,  is  apt  to  have  his  judgment 
questioned  as  that  of  a  visionary. 

It  seems  to  be  evident  that  medicine,  although 
appealing  to  almost  every  human  being  with 
fascinating  and  even  absorbing  interest,  must  be  a 
subject  which  presents  many  and  great  difficulties. 
The  differences  of  opinion  and  view  between  different 
medical  experts,  regarding  the  subject  matter  with 
which  they  deal,  offer  one  of  the  most  striking 
proofs  of  this.  Before  any  department  of  human 
affairs  can  be  said  to  be  understood,  the  facts  con- 
cerning it  must  be  clearly  stated,  they  must  be 
marshalled  in  a  more  or  less  complete  manner,  the 
law  or  laws  of  them,  or,  at  least,  their  natural  order 
declared,  and  their  causes  displayed.  When  these 
things  have  been  done,  and  particularly  when  the 
prediction  has  been  ventured  on,  and  verified,  as  to 
when  and  in  what  circumstances  the  facts  will  arise 
or  appear  on  the  one  hand ;  and,  on  the  other, 
by  what  means  their  existence  or  onset  may  be 
prevented,  then  the  phenomena  may  be  said  to 
have  been  scientifically  or  philosophically  arranged, 
verified  and  declared.  And  when,  or  if,  these  things 
shall  have  been  accomplished  in  Medicine,  obviously 
there  can  be  no  differences  of  opinion  or  view 
between  different  medical  experts ;  at  least,  no 
fundamental    contradiction   of    view,    although,    of 


course,  there  may  be,  and  must  be,  as  in  all  other 
branches  of  science,  some  or  even  considerable 
differences  of  opinion  as  to  less  or  more.  For  in 
medicine,  as  in  all  other  domains  of  knowledge,  the 
phenomena  dealt  with,  while  they  do  not  differ  in 
kind,  as  between  case  and  case,  do  differ  very 
materially  indeed  in  quantity  or  amount.  The  best 
theory  is  that  which  best  harmonizes  with  and 
accounts  for  the  facts.  And  it  is  interesting  to 
observe  how,  as  science  has  advanced  in  other 
departments  of  knowledge,  better  theories  have 
supplanted  worse  ones,  since,  as  knowledge  of 
medicine  advances,  the  same  thing  will  no  doubt 
be  observed,  one  department  of  knowledge  being 
governed  by  the  same  principles  as  obtain  in  other 
departments  of  inquiry  into  the  constitution  and 
course  of  nature.  An  illustration  from  the  history 
of  astronomy  may  perhaps  be  allowable  here  to 
shew  the  similarity  of  the  lines  of  inquiry  into  the 
course  of  nature  in  all  directions.  The  theory 
which  seems  so  natural  to  a  dweller  on  the  earth 
that  at  first  and  for  a  long  time  no  one  would  think 
of  questioning  it,  that  the  earth  is  of  very  great 
size,,  that  it  is  at  the  centre  of  the  universe,  and 
that  the  sun,  moon,  planets  and  fixed  stars  are 
revolving  round  it,  does  account  for  a  number  of 
astronomical  facts ;  it  is  only  when  it  is  found  that 
it  does  not  account  for  or  explain  a  large  number  of 
other  facts,  and  that  indeed  it  is  quite  incompatible 
with  and  opposed  to  them,  that  we  are  compelled  to 
discard  it  in  favour  of  one  which  supposes  the  sun 


to  be  more  or  less  fixed,  if  not  in  space,  at  least  in 
relation  to  his  own  sphere  of  action,  and  that  the 
planets  and  their  satellites,  our  own  small  earth 
included,  revolve  around  him.  But  just  as,  say,  six 
passengers  in  one  compartment  of  a  railway  carriage 
may  change  their  places  frequently  within  the  limits 
of  the  compartment  at  the  same  time  that  the  train 
may  be  carrying  them  all  rapidly  to  their  destina- 
tion, so  we  recognise  that  the  sun,  with  all  his 
attendant  planets  and  their  satellites,  may  be 
moving  onward,  and  that  even  rapidly,  to  some 
unknown  point  in  space.  The  wider  theory  sup- 
plants the  narrower  one  because  it  explains  more 
of  the  facts.  It  may  in  turn  be  destined  to  be 
supplanted  by  one  still  wider  if  it  shall  be  found 
that  some  astronomical  facts  are  not  explained  by 
the  theory  ;  but  in  the  meantime  all  astronomical 
experts  accept  the  theory  as  far  as  it  goes,  and 
none  are  to  be  found  who  oppose  it.  The  facts  of 
medical  science,  however,  are  much  more  compli- 
cated and  obscure  than  are  those  of  astronomy 
(albeit  to  work  out  the  complete  inter-actions  of 
even  three  bodies  obeying  the  law  of  gravitation 
transcends,  it  is  said,  the  highest  powers  of  mathe- 
matics, how  much  more  an  indefinite  number  of 
such  bodies  ?)  at  least  they  probably  are  so,  since  it 
is  not  uncommon  to  find  medical  experts  differing 
fundamentally  in  their  views  as  to  the  causation  of 
certain  conditions,  and,  therefore,  opposing  one 
another  in  their  recommendations  as  to  treatment. 
I  refer  particularly  to  the  facts  of  depression  or  of 


defect  or  deficiency  of  function,  as,  e.g.^  lowering 
of  the  temperature  of  the  body,  slowing  of  the 
pulse,  &c.,  of  which  some  account  will  have  to  be 
given  later.  Some  medical  experts  attribute  these 
conditions  to  causes  the  exact  opposite  of  those 
alleged  by  others  to  be  the  causes.  In  this 
particular,  however,  it  must  be  said,  the  public  are 
hard  to  please.  If  doctors  agree,  the  public  are  apt 
to  attribute  their  agreement  to  professional  or  class 
feeling ;  while,  if  they  differ,  they  are  apt  to  ask — 
who  shall  decide  ?  The  answer,  however,  when  or 
if  this  unfortunate  state  of  things  occurs,  is,  I 
should  like  to  say,  just  this.  The  public  must 
decide ;  each  man  for  himself  must  decide ;  reason 
and  judgment  must  decide.  The  duty  of  the 
public,  in  a  condition  of  opinion  so  unfortunate  as 
this,  is  to  receive  the  different  views,  to  ask  for  the 
reasons  given  in  support  of  each,  to  weigh  them  up 
as  far  as  judgment  and  reason  can  do  so,  asking,  if 
necessary,  for  help  from  other  persons  accustomed 
to  weigh  evidence  in  general,  in  order  to  be  able  to 
decide  which  of  the  opposing  views  is  correct ;  and 
to  act  accordingly.  Differences  of  opinion,  after 
all,  are  not  confined  to  medical  experts.  It  is 
doubtful  if  they  differ  from  one  another  as  often  or 
as  widely  as  lawyers  or  politicians  or  statesmen  or 
divines.  Emotion  sways  and  excites  men  in  their 
efforts  to  settle  differences  in  all  of  these  directions  ; 
but  nothing  and  no  expert  opinion  can  relieve  the 
individual  man  from  the  need  to  exercise  his  judg- 
ment,   his   reason,    and   his    conscience,   in   face   of 


10 

contradictory  advice  tendered  to  him  regarding  the 
interests  of  those  entrusted  to  his  care,  and  whom 
he  may  feel  to  be  dearer  to  him  than  his  own  life. 

A  very  noticeable  and  noteworthy  aspect  of 
the  diflBculties,  and  even  the  chaotic  disorder  of  the 
facts  with  which  medicine  has  to  deal,  appears 
when  we  think  of  the  widely  different  conditions 
with  which  she  has  to  occupy  herself.  I  mentioned 
fever,  inflammation,  tumour-growth  and  injury  a 
little  while  ago  as  examples  of  different  classes  of 
disease.  It  will  be  necessary  to  offer  definitions  of 
these  different  conditions  later,  so  as  to  separate 
them  from  one  another,  if  it  be  possible  to  do  so, 
and,  therefore,  to  be  able  to  say  what  we  mean 
when  we  say  that  one  person  has  a  fever,  and 
another  is  suffering  from  inflammation,  as  also  to 
say  how  these  states  of  body  are  to  be  prevented. 
But  before  we  reach  this  attempt  at  definition,  and 
of  clearing  up  of  confusion,  we  are  met  by  the 
difficulty  that  the  inflammations  themselves  are 
exceedingly  numerous — they  are  co-extensive,  in 
fact,  with  every  organ  and  even  with  every  tissue 
of  the  body — and  that  no  reason  appears  at  the 
outset  why  one  person  should  suffer  from  inflamma- 
tion of  the  throat  or  tonsillitis,  as  it  is  called, 
another  from  inflammation  of  the  lung  or  pneumonia, 
while  still  another  should  have  inflammation  of  the 
stomach  or  gastritis,  and  so  on  through  the  very 
numerous  list  of  the  inflammations.  The  explana- 
tion given  by  scientific  medicine  of  the  reason  why 
these  different  conditions  occur  in  different  persons 


11 

or  in  the  same  persons  at  different  times  is  not 
altogether  satisfactory,  albeit  it  is  all  that  has  been 
5'et  given,  and  apparently  all  that  ever  can  be  given 
to  us.  It  is  this.  One  person  is  said  to  have 
tonsillitis  rather  than  pneumonia  because  the  throat 
was  the  weaker  place  rather  than  the  lung,  while 
another  has  pneumonia  rather  than  tonsillitis  because 
the  lung  was  weaker  or  had  a  lower  resistance 
than  the  throat.  It  was  the  direction  of  his  least 
resistance,  as  the  expression  is.  But  if  we  come  to 
inquire  why  or  how  it  is  the  direction  of  least 
resistance,  it  is  not  always  possible  to  get  or  to  give 
an  answer.  Very  often  it  is  said  to  be  because  of  a 
previous  occurrence  of  that  affection  in  the  body. 
A  person  is  subject  to  recurring  attacks  of  tonsillitis, 
each  of  which  weakens  the  part  and  makes  it  more 
susceptible  to  subsequent  attacks.  The  insufficiency 
of  this  explanation,  however,  appears  when  we 
reflect  that  we  have  to  account  also  for  the 
occurrence  of  the  first  attack.  In  this,  as  in  all 
other  attempts  made  by  the  human  mind  at  scientific 
accuracy  and  explanation,  we  are  very  apt  to  become 
involved  in  a  process  of  circular  reasoning.  Thus 
we  say  the  tonsil  was  the  direction  of  his  least 
resistance ;  it  was  his  weakest  organ  or  place  ;  and, 
therefore,  he  got  tonsillitis.  And  we  also  say  that 
the  existence  of  the  tonsillitis  (rather  than  of 
pneumonia,  for  instance)  is  a  proof  that  the  tonsil 
was  the  direction  of  his  least  resistance.  We 
account  for  the  low  (or  least)  resistance  by  the 
tonsillitis,  and  we  account  for  the  tonsillitis  by  the 


12 

low  (or  least)  resistance.  The  same  difficulty  meets 
us  in  other  directions  in  scientific  inquiry.  We  say, 
for  example  (I  confine  myself  to  medical  illustra- 
tions, although  I  might  have  found  them  anywhere 
and  everywhere  in  other  departments,  as  philosophy, 
theology,  morals,  sociology,  &c.),  a  man,  his  father, 
and  his  grandfather,  all  suffered  from  bronchitis 
because  the  family  were  delicate,  and  we  advance  as 
the  reason  why  we  say  the  family  is  delicate,  the 
fact  of  the  occurrence  of  the  bronchitis  in  three 
generations  of  the  stock.  The  truth  seems  to  be  that 
scientific  explanations,  so  called,  cannot  explain 
anything,  and  themselves  in  turn  demand  explana- 
tion. To  say  that  a  man  had  tonsillitis  rather  than 
pneumonia  because  the  tonsil  was  the  direction  of 
his  least  resistance,  is  more  high-sounding  and 
pretentious  than  really  explanatory,  but  it  is  all  the 
explanation  which,  as  a  rule,  it  is  competent  for  us 
to  offer.  As  has  been  said,  the  difficulty  is  of  the 
same  kind  as  confronts  us  in  other  departments 
of  knowledge.  In  the  science  of  grammar,  for 
instance,  or  of  language,  if  we  want  to  know  the 
meaning  of  the  word  acute,  and  look  it  up  in  a 
dictionary,  we  shall  find  among  other  synonyms  the 
word  sharp  given  as  an  equivalent ;  and  if  we  look 
up  the  word  sharp  we  shall  find  among  other 
synonyms  the  word  acute  as  an  equivalent.  We 
can  never  get  beyond  our  limitations  in  our 
attempted  enquiries  into  nature,  and  it  is  hopeless 
to  attempt  to  do  so.  A  man  cannot  jump  out  of  his 
own   skin    or   get    away  from  his  own   shadow  in 


13 

sunlight.  The  brighter  the  sunhght  the  more 
noticeable  the  shadow.  In  the  obscurity  of  night 
there  is  no  shadow  at  all.  If  an  acute  critic 
suggests  that  in  my  attempt  to  clear  up  obscurity 
I  am  myself  guilty  of  a  similar  course  of  circular 
reasoning  in  using  such  terms  as  synonym  and 
equivalent,  he  may  be  correct ;  but  indeed  to  some 
extent  I  fear  it  is  impossible  to  avoid  it. 

The  obscurity  and  complication  of  the  facts 
with  which  she  has  to  deal  may,  therefore,  well  be 
advanced  as  a  reason  why  medicine  has  not  yet 
made  such  an  amount  of  scientific  advance  as  will 
be  necessary  before  she  becomes,  with  her  body  of 
rules,  formulated  for  the  guidance  of  humanity  to 
health,  a  light  to  the  path  and  a  lamp  to  the  eyes. 
This  obscurity  is  indeed  further  darkened  by  the 
fact  that  she  deals  with  conditions  and  states  of  the 
body  or  organism  rather  than  with  the  organism 
itself.  Almost  before  the  physician  has  formulated 
a  definite  conception  of  what  he  means  by  the 
organism  or  body,  in  health ;  before  he  has  had 
time  to  do  so,  he  finds  himself  attempting  to  under- 
stand various  alterations  or  changes  in  its  states, 
which  alterations  he  terms  disease,  and  which,  as 
they  are  the  subject  matter  of  his  art,  he  finds 
himself  compelled  to  define  for  himself,  and  also  to 
clearly  expound  to  others.  And,  in  order  that  he 
may  be  able  to  do  this,  it  is  plain  that  he  must 
make  a  long  and  wide  excursus  into  the  wanderjahre 
of  the  collection  of  facts,  before  he  can  settle  down 
into    the   lehrjahre   of   the    methodised  order   and 


14 

arrangements  of  his  facts.  When  or  if,  however, 
the  physician  can  succeed  in  doing  this,  when  he 
sees  the  order  and  the  laws  of  his  facts,  the  appUca- 
tion  of  discovered  laws  to  new  facts  must  result  in 
greater  simplification  of  the  facts,  in  the  diminution 
of  their  obscurity,  and  in  the  conversion  of  difficulty, 
disorder  and  darkness  into  perspicuity,  method, 
order  and  light.  It  is,  it  seems  to  me,  through  a 
study  specially  of  the  blood  and  lymph,  through 
examination  of  the  mode  of  their  formation,  of 
their  uses  and  functions,  and  of  their  conveyance  to 
and  their  circulation  in  every  one  of  the  tissues  of 
the  body,  that  this  order  and  methodised  arrange- 
ment are  to  be  introduced.  By  this  means  the 
chaos  of  the  incidence  of  disease  in  the  body  is  to 
be  reduced  to  order,  and  the  seeming  impossibility 
of  understanding  how  one  person  should  have  sore 
throat,  another  headache,  another  bronchitis,  another 
pneumonia,  another  rheumatism,  another  inflamma- 
tion of  the  heart,  and  so  on  through  a  catalogue  of 
diseases  that  seems  interminable — the  same  person 
may  at  different  times  of  life  suffer  from  any  or  all 
of  these  affections,  and  from  a  large  number  more — 
it  is  through  a  study  of  the  circulation  of  the  blood 
and  lymph  that  these  disorders  are  to  be  understood 
and  the  laws  of  their  incidence  seen.  For,  truly, 
as  soon  as  it  is  perceived  that  the  same  blood  goes 
everywhere  in  the  body,  and  when  it  is  seen  that  if 
the  blood  is  properly  and  healthily  made,  it  will 
nourish  properly  every  organ  and  tissue  of  the 
body,  while,  if  it  is  not  healthily  or  properly  made, 


15 

it  cannot  do  so,  and  must,  therefore,  instead  of 
carrying  health  to  them,  convey  disease ;  and  when, 
lastly,  a  little  observation  and  reflection  have  been 
given  to  the  mode  of  formation  and  repair  of  the 
blood,  then  it  is  that  chaos  is  replaced  by  order, 
confusion  by  simplicity,  and  darkness  by  light. 

Medicine  has,  however,  already  made  much 
scientific  advance.  In  the  whole  of  anatomy  her 
method  is  scientific,  and  in  much  of  physiology, 
pathology,  and  the  principles  of  therapeutics, 
though  scarcely  in  pharmacology.  The  methods  are 
also  scientific  in  subsidiary  domains  like  chemistry. 
Bacon's  dictum  regarding  medicine  that  it  has  been 
magis  elahorata  quani  amplificata,  rather  laboured 
than  advanced,  is,  if  it  cannot  be  said  to  be  totally 
untrue,  at  least  much  less  true  than  when  he  said  it. 
But  there  is  one  other  great  reason  for  medicine's 
failure  to  make  so  great  an  advance  into  the 
scientific  arena  as  we  might  have  expected,  a  reason 
which  she  shares  with  some  other  departments  of 
enquiry,  and  which  is  apt  equally  to  complicate 
their  investigation,  viz.,  what  has  been  called  the 
difficulty  of  the  personal  equation.  Phenomena 
which  ought  to  appear  the  same  seem  often  to  difier 
very  much  indeed  when  manifested  by  this,  that 
or  the  other  person  or  organism,  just  as  in  sociology 
or  in  politics  phenomena  are  often  very  different 
when  manifested  by  this,  that  or  the  other 
personality,  or  by  this,  that  or  the  other  difierent 
nationality.  Physiological  and  medical  phenomena 
are  not  like  mathematical  facts,  in  which  we  can 


16 

discard  variables  like  the  widths  of  lines,  and  the 
magnitudes  of  points,  without  seriously  vitiating 
our  conclusions.  In  medicine,  the  analagous 
variables  have  much  more  weight  and  influence, 
and  if  we  attempt  to  discard  them,  as  in  mathe- 
matics we  may  the  width  of  our  lines  and  the 
magnitude  of  our  points,  we  shall  find  our  con- 
clusions seriously  vitiated  and  interfered  with. 

There  is  even  a  special  form  of  the  personal 
equation  which  is  more  apt  to  disturb  the  judg- 
ment and  the  equanimity  of  the  medical  man 
than  that  of  the  representative  of  almost  any 
other  calling,  unless  indeed  it  be  the  pastor  and 
preacher,  and  that  is  the  unwillingness  manifested 
by  the  average  human  being  to  seriously  con- 
sider any  advice  which  involves  the  giving  up  of 
any  personal  gratification  or  which  contemplates 
in  any  form  the  idea  of  self-restraint  or  self- 
government.  Now  it  is  very  frequently  the  case 
that  the  medical  man  is  called  upon  to  point  out 
that  some  form  of  self-indulgence  is  the  cause  of 
the  ailments,  and  particularly  of  the  recurring 
ailments,  from  which  patients  suffer.  In  this  case 
he  feels  it  to  be  his  duty  to  say  what  he  has  to  say, 
but  is  afraid  how  it  will  be  received,  and  often 
indeed  feels  that  saying  it  may  lead  to  a  breach 
between  himself  and  his  client,  a  contingency  which 
he  is  on  all  grounds  anxious  to  avoid.  It  will  be 
felt  perhaps  how  very  delicate  the  position  becomes 
if,  for  instance,  a  mother  is  not  excercising  a  wise 
government  over  her  children's  food-habits,  and  if 


17 

in  consequence  the  children's  health  is  suffering.  It 
might  be  thought  perhaps  that  mothers  would  be 
only  too  happy  to  know  what  would  prevent  their 
children's  illnesses,  and  would,  therefore,  be  only 
too  glad  to  do  anything  to  obviate  them.  But  a 
great  many  considerations  arise  to  prevent  their 
taking:  such  a  course,  mosth'  of  a  social  nature,  and 
coming  through  channels  which  it  is  very  difficult  to 
control.  And,  of  course,  at  bottom  there  is  great 
dislike  to  imposing  limits  either  to  our  own  gratifi- 
cation or  to  that  of  our  children.  Then  again, 
other  exponents  of  medical  views  may  not  have 
such  strong  opinions,  and  for  these  and  many  other 
reasons  which  perhaps  are  as  well  unexpressed,  the 
happy  relations  which  it  is  so  desirable,  if  possible, 
to  maintain  between  adviser  and  client  are  apt  to 
come  to  an  end ;  and  this  however  tactfully  the 
unpleasant  advice  has  been  offered,  and  however 
well  the  unpalatable  pill  has  been  gilded.  Perhaps 
these  difficulties  are  as  great  in  other  walks  of  life. 
Each  person  gets  to  know  them  in  his  own  depart- 
ment. It  does  not  seem  possible  to  go  through  life 
very  smoothly,  however  careful  one  may  be  to  avoid 
causes  of  offence.  Still  each  must  judge  for  himself 
how  far  he  ought  to  go  in  attempting  to  hold  the 
balance  even  between  a  tactful  desire  to  please  and 
a  compulsion  laid  on  him  to  interpret  the  facts  and 
the  law  of  the  facts  truly  as  far  as  in  him  lies. 

The  variabilities  in  the  phenomena  with  which 
medicine  has  to  occupy  herself,  the  obscurities  and 
the   indefiniteness  of  them  become  greater  rather 


18 

than  less  when  we  come  to  consider  more  closely 
what  medicine  is.  Medicine  is  a  science,  or  it  may 
come  to  be  a  science  of  conditions,  of  the  conditions 
of  the  human  body  in  disease.  An  extension  of 
the  domain  to  cover  the  field  of  animal  medicine, 
and,  still  further,  to  cover  the  field  of  orgajiic 
medicine,  that  is,  the  medicine  of  organic  or 
organised  things  (animal  and  plant),  would  very 
greatly  widen  its  scope.  It  would,  that  is,  greatly 
widen  it  as  regards  details,  though  as  to  principles 
this  might  be  doubted.  However,  with  this  we 
need  not  at  present  concern  ourselves.  It  is 
sufficiently  difficult  and  confusing  to  deal  with  the 
disease-conditions  of  the  human  body,  as  these 
pass  by  gradations  almost  insensible  from  conditions 
of  health  to  those  of  disease.  Disease  being  any 
and  every  departure  from  health,  the  question  at 
once  is  forced  on  us  for  consideration — What  is 
health  ?  Can  we  define  health  ?  There  have  been 
many  definitions  or  descriptions  of  health,  none  of 
them  theoretically  perfect,  yet  practically  of  good 
service  in  clearing  the  mind  of  confusion.  If,  for 
example,  we  say  that  health  is  the  normal,  easy 
and  painless  balance  between  the  organism  and  its 
environment,  and  that  disease  is  any  departure 
therefrom,  we  have  a  practical  definition,  though  by 
no  means  a  theoretically  good  one,  of  health  and 
disease  respectively ;  since  the  question  at  once 
arises  what  a  normal  balance  is,  and  the  settlement 
of  this  and  similar  questions  reaUy  involves  the 
definition    of    what    health    is,    so    that    we    find 


19 

ourselves   unconsciously  begging   the  question  and 
moving  in  a  circle. 

The  reader  will  think  of  Mr.  Herbert  Spencer's 
definition  of  life,  that  it  is  "  the  continuous  adjust- 
ment of   internal   relations  to  external   relations," 
and  will  ask  if  this  statement  is  a  simplification  of 
his  ideas  of  life,  or  otherwise.     What  we  want  in  a 
definition  is  something  that  will  make  the  idea  or 
the  thing  easier,  simpler  than  it  was  before.     If,  we 
say,   trying  to  get  a   practical  working   definition 
that  disease  is  any  and  every  condition  in  which  the 
doctor  is  sent  for,  we  are  forced  at  once  to  reflect 
that   the   doctor   is   not    always    summoned   when 
disease  sets  in,  and  also  that  persons  are  not  always 
ill  when  they  summon  the  doctor,  since  they  may 
want  a  certificate  that  they  are  well,  or  a  statement 
from  him  that  they  are  fit  to  join  the  army  or  navy, 
or,  for  example,  that  they  are  safely  insurable,  or 
that  they  are  able  to  perform  this,  that  or  the  other 
piece  of  work.     The  truth  is,  it  is  almost  impossible 
to   give   a  definition  of  health,    and,   therefore,   of 
disease,  which  is  any  departure  therefrom,  without 
introducing    by   paraphrase,   if  not    explicitly,   the 
very  word  or  idea  which  we  wish  to  define.     To 
say,    for   instance,    that   health    is   organisation    in 
normal,  easy  and  painless  action,  sounds  well  until 
we   ask  what   is   ' '  normal   action,"   and  when   we 
attempt  to  answer  this  question  we  find  that  normal 
action  and  health  is  much  the  same  thing,  so  that 
our  high  sounding  definition  seems  in  the  end  to 
come    to    the    statement    that    health   is    health, 

B2 


20 

which,  though  undoubtedly  true,  is  by  no  means 
instructive.  If  instead  of  a  definition  we  attempt 
a  description  of  health,  and  say  that  an  organism  is 
healthy  when  the  pulse  is  not  below  say  60  a 
minute,  nor  above  90,  when  the  temperature  stands 
at  about  98 '4°  F.  or  37°  C. ,  when  the  respiration 
varies  from  14  to  20  a  minute,  when  the  bowels  act 
once  a  day,  and  40  to  60  ounces  of  water  are  passed 
daily  by  the  kidneys,  all  these  functions  being 
easily  and  painlessly  performed ;  and  so  on,  through 
all  the  functions  of  the  body  (and,  it  might  have 
been  added,  of  the  mind  also),  we  soon  realise  that 
the  idea  of  health,  simple  as  we  thought  it  on 
commencing  our  study,  is  a  very  complicated  aifair 
indeed,  and  that  our  ideas  concerning  it,  instead  of 
becoming  more  and  more  simple,  become,  if  not 
more  and  more  obscure,  yet  at  least  more  and  more 
extended.  Without,  therefore,  assuming  more  for 
our  definition  of  health  than  it  is  reasonable  to  claim 
for  it,  and  without  attaching  too  much  importance 
to  our  attempts  at  description,  since  our  limits  of 
variation  may  easily  be  exceeded  without  departure 
from  health,  we  must  leave  attempts  at  definition 
and  description  and  pass  on  to  the  consideration  of 
the  subject  of  health  and  its  co-relative  disease. 


'rJ^S^ii^V^?^^^ 


21 


CHAPTEE    I. 


The  Problem  stated.  The  present  state  of 
Medicine  and  Surgery,  and  their  progress 
in  the   past. 


TN  current  literature,  professional  and  lay,  we 
are  continually  being  told  of  the  progress  of 
medicine  and  surgery.  I  shall  have  to  say  some- 
thing from  time  to  time  in  the  course  of  these 
observations  regarding  the  latter,  although  my 
remarks  are  mainly  confined  to  medicine.  I  think 
there  is  too  much  surgery  performed  in  England 
and  the  world  at  present.  There  can  be  no  doubt 
that  many  diseased  conditions,  which  it  is  now  the 
custom,  and  which  it  has  been  increasingly  the 
custom  for  some  time  past,  to  treat  surgically, 
might  be,  and  much  more  satisfactorily,  treated 
medically,  that  is,  by  medical,  and  particularly 
by  dietetic  management.  The  cry  of  "  operate, 
operate,"  is  becoming  too  loud,  and  people  are 
stretching  out  in  too  marked  a  manner  mute  hands 
appealing  to  surgery  for  help,  and  are  tending  to 
expect  too  much  from  surgical  operations.  When  a 
surgeon  takes  upon  himself  to  say  that  a  natural 
structure  is  "  obsolete  and  out  of  date,"  suggesting, 
by  implication  at  least,  that  all  might  yet  be  well  if 


22 

he  were  called  in  to  remove  it  by  surgical  operation, 
his  mental  attitude,  as  well  as  the  language  in 
which  he  expresses  it,  strikes  us  as  with  a  jar. 
And  when  he  goes  on  to  say  "it  is  safe  to  predict 
that  in  the  intestine  of  the  man  of  the  future 
there  will  be  no  such  structure  (as  the  vermiform 
appendix)  found  hanging  from  the  caecum,"  one  is 
inclined  to  say,  it  is  unwise  to  prophesy  unless  you 
know.  But  if  one  is  going  to  venture  on  prophecy, 
it  is  certainly  clever  to  predict  that  something  will 
occur  or  will  not  occur  at  a  period  of  time  so  remote 
that  neither  the  prophet  nor  any  of  his  hearers 
will  be  here  to  see  the  prophecy  verified,  or  to  be 
disturbed  if  it  is  not  verified.  The  prophet  who 
predicted  the  end  of  the  present  dispensation  in  20 
years  gave  his  auditors  a  much  better  chance. 
They  could  verify  the  truth  or  otherwise  of  the 
prediction.  But  although  this  particular  prophecy 
cannot  be  verified  in  any  reasonable  time,  a  simple 
sum  in  proportion  rises  to  the  mind  on  reading  rash 
and  arrogant  statements  of  this  kind,  viz.,  this:  if 
5,000  years  (or  50,000  or  more  years,  for  it  seems 
not  impossible  that  men  may  have  been  on  this 
planet  for  even  that  length  of  time)  have  not 
sufficed  to  abolish  the  vermiform  appendix  of  the 
caecum,  what  likelihood  is  there  that  it  will  evolve 
to  nothing  in  1000  years  hence,  or  2000  or  3000 
years  ?  It  does  seem  a  pity  that  men  so  able  and 
so  knowing  had  not  been  entrusted  with  the 
making  of  man  and  of  the  world  on  which  he  was 
to  dwell.     They  could  have  done  the  work  so  much 


23 

"better.  And  what  a  number  of  useful  hints  have 
been  lost  because  they  were  not  consulted  when  the 
thankless  task  of  fashioning  them  was  in  course  of 
being  accomplished.  A  structure  rich  in  lymphoid 
elements  has  probably  a  useful  part  to  play  in  the 
economy,  and  it  would  be  far  more  useful  to  poor 
and  suffering  humanity,  though  possibly  less  imme- 
diately beneficial  to  the  prophets,  to  advise  it  how 
to  keep  the  appendix  vermiformis  and  other  parts 
sound  and  healthy  than  to  proceed  to  remove  them 
in  the  way  that  is  now  so  freely  proposed  and 
carried  out.  Even  after  the  appendix  is  removed, 
the  ^caecum  or  other  parts  of  the  intestine  may 
become  inflamed,  and  the  appendix-less  patient  may 
still  suffer  from  inflammation  of  the  caecum  or  of 
the  bowel,  from  peri-typhlitis  or  enteritis.  Are  we 
to  excise  the  caecum  in  order  to  prevent  typhlitis  or 
peri-typhlitis  ?  or  the  bowel,  in  order  to  prevent 
enteritis  ?  Or  would  it  be  wise  to  amputate  the 
head  in  order  to  prevent  neuralgia  of  the  face  ? 

Obviously,  if  the  causes  which  lead  to  the 
formation  of  some  growth  or  abnormality  in  the 
body,  or  to  some  local  inflammation  in  it,  are 
allowed  to  go  on  acting  after  the  inflanunation  has 
•subsided,  or  after  the  growth  or  abnormality  has 
been  removed,  either  a  recurrence  of  the  growth  or 

*NoTE. — Caecum  is  the  Latin  for  blind,  the  Greek  equivalent 
being  tv^Xov.  The  name  is  given  to  that  part  of  the 
bowel  where  the  large  intestine  commences  as  a  cul  de  sac 
or  blind  part,  that  is,  with  no  passage  through  at  that 
place.     The  appendix  vermiformis  springs  from  this  part. 


24 

abnormality,  or,  when  that  is  not  possible,  some 
other  abnormality  or  diseased  condition  must  be 
expected  to  occur  in  the  body.  Many  instances  of 
this  have  come  under  my  observation,  as  they 
must  have  done  under  the  observation  of  every 
experienced  practitioner.  A  patient  who  gets  sore 
throat,  for  example,  or  bronchitis,  may,  and  not 
infrequently  does,  get  another  and  another  attack  of 
the  same  affection,  if,  when  the  inflammation  has 
been  subdued  by  treatment,  nothing  is  said  to  him 
as  to  the  causes  which  led  to  his  successive  attacks. 
The  well-known  fact  that  the  removal  of  a  simple 
ovarian  tumour  is  frequently  followed  some  years 
afterwards  by  the  formation  of  cancer  about  the 
stump  of  the  simple  tumour,  is  a  striking  corrobora- 
tion of  the  truth  of  this  view,  as  it  also  suggests  to 
our  minds  that  the  causes  of  simple  tumour  and  of 
malignant  or  cancerous  tumour  are  probably  the 
same,  and  that  the  long  continuance  of  the  action 
of  the  causes  of  simple  tumour-growth  leads  in 
time  to  the  production  of  cancerous  growth.  In 
any  case,  every  experienced  surgeon  must  have 
heard  from  time  to  time  the  statement — "  I  am 
much  disappointed  with  the  result  of  my  opera- 
tion." Surgery  has  its  sphere,  no  doubt,  and  a 
very  great  one,  but  it  seems  at  present  to  be 
overdone.  But  I  do  not  wish  to  enter  into  any 
considerations  of  this  sort.  I  do  not  deny,  I  rather 
re-echo,  the  assertion  that,  where  operations  are 
necessary,  they  are  much  safer  in  the  performance 
and  much  more  curative  in  their  results  than  they 


25 

used  to  be.  Nevertheless,  and  notwithstanding  the 
brilliancy  and  striking  character  from  time  to  time 
of  the  results  of  surgery,  it  has  not  done  much  for 
the  lengthening  of  the  life  of  the  people.  Com- 
pared with  the  results  achieved  by  medicine^ 
meaning  by  that  name  not  only  pharmaceutical  but 
also  sanitary  and  hygienic  measures,  the  results  of 
surgery  have  been  in  the  aggregate  very  small 
indeed,  As  to  medicine,  however,  what  has  been 
the  result?  In  the  year  1838  the  Eegistrar-General 
began  to  compile  his  figures  for  England  and  Wales, 
and  in  the  years  1838-40  the  death-rate  for  the 
country  was  22-33  per  1000  per  annum.  In  the 
years  1898-1900  (60  years  after)  the  death-rate 
averaged  18  per  1000  per  annum,  a  fall  of  about  20 
per  cent.  It  would  be  a  crude  inference  from  these 
figures  to  assume,  dividing  1000  by  the  ratio  per 
thousand  per  annum,  that  the  average  duration  of 
life  for  these  sets  of  years  had  been  forty-four  and 
three-quarter  years  for  the  first  period,  and  no  less 
than  fifty-five  and  a  half  years  for  the  second. 
Nevertheless,  the  expectation  of  life  is  now  con- 
siderably greater  in  England  and  Wales  than  it 
was  when  the  Registrar-General  began  to  compile 
his  figures.  A  very  interesting  set  of  tables  has 
been  published  in  the  supplement  to  the  forty-fifth 
annual  report  of  that  official,  from  which  it  will  be 
advisable  to  extract  a  few  facts.  It  would  take  too 
long  a  time  and  occupy  too  much  space  to  deal 
completely  with  the  information  contained  in  this 
and  previous  reports  ;  but  it  appears  if  we  compare 


26 

the  expectation  of  life  at  birth  at  different  periods  of 
time  in  England,  that  a  very  considerable  improve- 
ment has  been  effected.  Thus  in  the  16  years, 
1838-54,  the  expectation  of  life  at  birth  for  males 
was  39*91  years.  In  the  10  years,  1871-80,  how- 
ever, it  had  risen  to  41  "35  years,  and  in  1881-90  it 
reached  43*66  years.  For  females  the  corresponding 
expectations  were: — For  1838-54,  41*85  years;  for 
1871-80,  44-62  years;  and  for  1881-90,  no  less  than 
47  "18  years.  If  we  were  to  assume,  which  is  not 
the  case,*  that  the  numbers  of  males  and  females 
were  equal,  this  would  mean  an  increase  in  1881-90 
over  1838-54,  to  the  average  duration  of  life,  of 
about  four  and  a  half  years.  If  this  number  were 
multiplied  by  32|^  millions,  the  estimated  population 
of  England  and  Wales  in  1900  (supposing  the 
improvement  still  to  hold),  no  less  a  sum  would  be 
reached  than  145,125,000  years  of  life  as  added 
to  the  life-time  of  the  generation  now  living  in 
England  and  Wales,  as  compared  with  the  conditions 
obtaining  in  1838-54.  For  the  United  Kingdom 
the  corresponding  addition  would  be  no  less  than 
180,000,000  years  of  life.  Numbers  like  this  strike 
the  imagination  with  some  of  the  surprise  excited 
by  the  figures  dealt  with  in  astronomical  enquiries  ; 
but  so  far  as  can  be  seen,  they  seem  fairly  to 
represent  the  gross  increase,  medical  and  surgical, 
made  in  the  last  60  years  in  the  life  duration  of  the 
people  of  this  country.     If  similar  gains  have  been 

*NoTE. — In  1881-90,  out  of  a  million  children  born,  485,527  were  males, 
and  514,473  females. 


27 

effected  (as  to  some  extent  they  have)  in  other 
countries,  the  life  gains  to  humanity,  made  by  a 
diminished  mortahty,  must  be  very  great  indeed. 
Beside  numbers  Hke  these,  even  the  addition  of 
30,000  years  of  life,  which  a  great  ovariotomist 
recently  claimed  that  he  had  made  through  his  own 
personal  instrumentality  to  the  life-time  of  his  day 
and  generation  (great  as  it  undoubtedly  is  as  the 
influence  of  one  man,  now  happily  imitated  by  many 
others),  pales  into  insignificance.  It  illustrates  the 
different  figures  dealt  with  by  medicine  and  surgery 
respectively.  When  the  surgeon  speaks  of  adding 
thousands  of  years  of  life  to  his  generation,  the 
physician  (as  represented  by  hygiene  and  sanitation) 
speaks  of  millions.  The  millions  no  doubt  include 
the  thousands,  but  the  total  result  goes  to  show 
that,  great  as  the  influence  of  improved  surgery 
has  been,  it  has  been  comparatively  small  as  com- 
pared with  that  of  improved  medicine,  speaking  of 
it  in  its  widest  sense.  And  further,  sanitation  is 
without  drawback,  which  surgery  is  not.  For,  in 
considering  the  improvement  effected  by  the  latter, 
we  are  compelled  to  remember  that  at  least  some 
lives  have  been  shortened  where  surgical  operations 
have  ended  fatally  ;  since  it  cannot  be  contended 
that  all  the  lives  cut  short  by  surgical  operations 
would  have  been  terminated  so  soon  had  the  patients 
been  left  alone.  It  will  never  be  known  to  what 
figures  such  losses  would  amount  ;  but  whatever 
they  are,  they  ought  to  be  deducted  from  the  gross 
addition  made  to  human  life  by  surgery.     On  the 


28 

other  hand,  all  that  is  added  to  human  life  by 
sanitation  is  pure  gain  —  we  must  hold  with 
Socrates  that  6  yStos  /Stwros,  ' '  life  is  worth  living  " 
— for  I  think  I  need  not  now  and  here  discuss 
the  question,  already  settled,  whether,  in  saving 
the  weaklings,  sanitation  can  in  any  sense  be 
said  to  have  deteriorated  the  race.  Assuming 
that  as  settled,  the  question  remains  in  what 
forms  the  gains  have  been  effected.  I  hope  to 
consider  the  increase  in  the  duration  of  life  at 
different  age  periods  later.  In  the  meantime,  it 
may  be  said  that  the  gains  on  the  large  scale  in  the 
last  50  or  60  years  have  been  mainly  two.  We 
have  very  much  diminished  the  mortality  from  the 
fevers,  or  what  are  known  as  the  zymotic  diseases, 
and  we  have  very  much  diminished  the  mortality 
from  consumption.  In  the  five  years,  1850-4,  the 
mortality  from  the  fevers  amounted  to  5'^34  per 
million  per  annum  on  the  average.  In  the  five 
years,  1875-9,  it  had  fallen  to  3911  per  million  per 
annum.  In  1871-80  the  average  mortality  from  the 
zymotic  diseases  in  England  and  Wales  was  at  the 
rate  of  3724  per  million  per  annum.  In  the  five 
years,  1881-5,  it  averaged  2797;  in  1886-90  it  was 
2506;  in  the  decennium  1881-90  it  averaged  2656. 
In  1891-5  it  was  2747.  The  average  of  1889  to 
1898  was  at  the  rate  of  2663  per  million  per 
annum,  the  rate  in  1897  being  2811.  The  rate  has 
been  rather  upwards  in  the  last  few  years.  The 
decennium,  1889-1898,  has  shewn  no  less  mortality 
from  this  cause  than  the  decennium  ending  in  1890  ; 


29 

it  is,  in  fact,  rather  higher  if  anything  ;  but  the 
rate  in  the  decennium  ending  1898  has  been  less 
than  that  of  the  five  years  ending  1854  by  no  less 
than  about  one-half,  or  49  per  cent.  Why  this  is, 
is  an  interesting  question,  which  I  propose  to 
discuss  later. 

In  the  case  of  consumption,  the  mortality  in 
the  five  years,  1850-54,  was  at  the  rate  of  2811  per 
million  per  annum.     This   had  fallen  to   2130  per 
million  per  annum   in   the   five  years   1875-9.     In 
1881-5  the  mortality  was  at  the  rate  of  1830  per 
million   per  annum;    in   1886-90,  it  was  1635;    in 
1891-5,  it  was  1461  ;  and  in  1896-1900  it  was  1321 
per   million   per   annum ;    so   that   the   fall  in  the 
mortality  from  consumption  in  England  and  Wales 
since  1850-4  has  been  no  less  than  53  per  cent.,  or 
considerably  over  one  half.     And  both  in  the  case 
of  the  fevers  and  in  that  of  consumption  the  gain 
to  the  health  of  the  community  must  be  considered 
most  satisfactory,  more  so  perhaps  in  the  case  of 
consumption  than  in  that  of  the  fevers,  since  the 
fall   in   consumption   appears    to   be   still    steadily 
progressing,  while  that  from  fevers  has  been  some- 
what checked.     It  may  also  be  noted  in  passing  as 
regards    consumption,   that    the   diminution   in    its 
mortality    had    begun    steadily   to    progress    long 
before   any   special    crusade   against   it    had    been 
instituted,   and  that,  good  as  that  crusade  is,  and 
laudable  in  its  attempted  results,  we  must  be  careful 
of  attributing  to  it  efiects  beyond  those  to  which  it 
may  be  fairly  entitled. 


30 

Besides  these  gains  to  the  health  of  the  people, 
known  to  have  accrued  during  the  registration 
period,  there  are  others  of  a  very  satisfactory 
character.  The  following  table,  copied  from  the 
report  of  the  Registrar- General  for  England  and 
Wales  for  1900,  will  shew,  for  those  who  are 
interested  in  such  inquiries,  the  diminution  which 
has  been  occurring  in  the  mortality  of  the  people 
since  1838,  when  the  Registrar. General  first  began 
to  compile  his  figures  : — 


31 

ENGLAND  AND  "WALES.— Annual  Death-rates  at  Twelve  Age-periods  in 
Groups  of  Years,  1838-1900. — Males  and  Females. 


Pebiod. 

AGES. 

All 

Ages 

0- 

1 
1 

5— 

10— 

15— 

20- 

25— 

35— 

45— 

55— 

65— 

75— 

85 

and 

upwards. 

1838  ■) 

DEATHS    TO    1000    LIVING. 

MALES. 

to      [ 

221 

683 

7-1 

40 

56 

76 

90 

12-8 

19-0 

33-5 

681 

147-6 

308-8 

1900  ) 

1841-50 

231 

71-2 

9-2 

5-1 

7-1 

9-5 

9-9 

12-9 

18-2 

31-8 

67-5 

143-3 

.312-3 

1851-60 

23-1 

727 

8-5 

4-9 

67 

8-8 

9-6 

12-5 

18-0 

31-0 

65  "5 

1467 

308-2 

1861-70 

237 

73-5 

8-2 

4-5 

6-2 

8-5 

9-9 

13-5 

19-2 

331 

67-1 

147-2 

315-0 

1871-80 

227 

68-5 

67 

37 

5-3 

7-4 

9-4 

13-8 

20-1 

.34-9 

697 

150-8 

3-27-4 

1881-90 

20-3 

61-6 

5-4 

3-0 

4-3 

57 

7-8 

12-4 

19-4 

347 

70-4 

146-6 

305-8 

1891-1900 

19-3 

60-8 

4-2 

2-4 

3-8 

5-2 

7-0 

11-9 

19-4 

35-8 

69-0 

1470 

285-1 

1841-45 

22-2 

687 

8-8 

4-8 

6-8 

9-0 

9-4 

12-2 

17-2 

30-3 

65-5 

143-7 

305-1 

1846-50 

24-1 

7-38 

9-5 

5-4 

7-3 

10-0 

10-5 

13-6 

19-2 

33-2 

69-5 

1530 

319-5 

1851-55 

23-5 

73-9 

8-8 

51 

7-0 

9-2 

100 

12-9 

18-6 

31-5 

66-6 

150-8 

311'0 

1856-60 

22-6 

71-5 

8-3 

4-6 

6-4 

8-4 

9-2 

12-2 

17-4 

30-4 

64-3 

142-6 

305-4 

1861-65 

237 

74-0 

8-5 

47 

6-4 

87 

97 

13.2 

18-9 

32-8 

66-3 

145-8 

316-4 

1866-70 

237 

72-9 

7-9 

4-3 

60 

8-3 

101 

13-8 

19-6 

33-5 

678 

148-7 

313-6 

1871-75 

23-3 

69-9 

7-1 

4-0 

57 

8-1 

100 

14-3 

20-3 

34-8 

70-0 

149-5 

323-3 

1876-80 

22-1 

670 

6-3 

3-4 

49 

67 

87 

13-4 

19-8 

34-9 

69-4 

152-2 

331-6 

1881-85 

20-5 

61-3 

5-8 

3-2 

4-5 

60 

8-2 

12-8 

19-3 

34-2 

687 

145-4 

297-8 

1886-90 

20-0 

61-9 

4-9 

2-8 

4-1 

5-5 

7-4 

12-0 

19-4 

35-2 

721 

147-9 

313-8 

1891-95 

19-8 

62-0 

4-5 

2-5 

40 

5-3 

7-2 

12-1 

19-8 

36-3 

71-8 

149-7 

290-1 

1896-1900 
1838   •) 

18-8 

59-6 

3-8 

2-2 

3-5 

51 

67 

117 

19-0 

35-3 

66-2 

144-3 

280-2 

FEMALES. 

to       f 

200 

58-4 

69 

41 

60 

7-2 

8-8 

ire 

15-5 

28-2 

59-9 

133-9 

282-1 

1900   ) 

1841-50 

21-6 

61-1 

8-9 

5-4 

7-9 

9-1 

10-6 

12-9 

16-1 

28-4 

60-9 

135-9 

293-3 

1851-60 

21-4 

630 

8-4 

5-1 

7-4 

8-6 

10-0 

12-2 

15-3 

27-1 

58-9 

134-5 

288-9 

1861-70 

21-4 

637 

7-8 

4-5 

67 

8-0 

97 

12-1 

15-6 

27-9 

59-1 

134-9 

285-1 

1871-80 

20-1 

58-4 

6-3 

37 

5-5 

6-8 

8.6 

il-6 

15-6 

287 

61-0 

135-4 

296-4 

1881-90 

18-1 

52-0 

5-3 

3-1 

4-4 

5-5 

74 

10-6 

15-1 

28-5 

60-4 

130-6 

270-8 

1891-1900 

17-1 

50-9 

4-2 

3-5 

37 

4-6 

6-3 

9-9 

14-9 

29-0 

60-0 

133-5 

259-6 

1841-45 

20-6 

58-6 

8-6 

5-2 

77 

8-6 

9-9 

12-2 

15-1 

27-2 

59-1 

131-8 

288-6 

1846-50 

22-6 

637 

9-2 

57 

8-1 

9-6 

11-2 

137 

17-0 

297 

62  8 

140-1 

297-9 

1851-55 

21-8 

63-8 

8-5 

5-3 

7-8 

8-9 

10-3 

12-6 

15-8 

27-8 

59-6 

1371 

292-0 

185&-60 

21-0 

62-3 

8-3 

4-8 

7-1 

8-2 

9-6 

11-9 

14-8 

26-5 

58-1 

131-9 

285-8 

1861-65 

21-5 

64-1 

8-3 

4-8 

6-9 

8-2 

9-8 

12-1 

15-5 

27-9 

59-1 

133-7 

287-7 

1866-70 

21-2 

63-3 

7-4 

4-3 

6-4 

7-8 

9-6 

12-1 

15-8 

27-9 

59-1 

1361 

282-4 

1871-75 

207 

60-0 

6-6 

4-0 

5-9 

7-4 

9-2 

120 

15-9 

287 

61-2 

135-3 

293-8 

1876-80 

19-5 

56'8 

5-9 

3-5 

5-0 

6-2 

8-0 

11-2 

15-4 

28-6 

60-8 

135'4 

299-0 

1881-85 

18-3 

51-9 

57 

3-5 

47 

5-9 

7-9 

11-0 

15-2 

28-1 

59-0 

128-9 

265-4 

1866-90 

17-8 

52-0 

4-9 

2-9 

4-1 

5-2 

6-9 

10-3 

15-0 

28-8 

617 

132-3 

276-2 

1891-95 

177 

51-9 

4-5 

27 

40 

4-9 

67 

10-3 

15-3 

29-8 

627 

135-8 

263-2 

1896-1900 

16-6 

49-9 

3-9 

2-3 

3-3 

4-3 

5-9 

9-6 

14-5 

28-1 

57-4 

131-2 

255-9 

32 

The  analysis  of  these  figures  in  detail  would 
probably  weary  and  confuse  most  readers,  who  will 
from  personal  examination  of  the  table  find  much 
to  interest  and  instruct,  and  that  in  a  better  way 
than  any  analyst  can  do  it  for  them.  But  the 
following  few  observations  may  be  made.  First  as 
regards  females,  with  the  exception  of  the  age 
periods  55-65  and  65-75,  the  mortality  is  less  in 
1891-1900  than  it  was  on  the  average  of  the  years 
1838-1900,  the  whole  period  for  which  the  figures 
have  been  kept.  Thus  we  find  that  the  general 
mortality  at  all  ages  had  fallen  from  20  per  1000 
per  annum  to  17*1  per  1000  in  1891-1900.  From 
0-5  years  it  had  fallen  from  58*4  per  1000  to  50*9. 
From  5-10  years  of  age  it  fell  from  6*9  to  4  "2. 
From  10-15  years  of  age  it  fell  from  4*1  to  2*5. 
From  15-20  years  of  age  it  tell  trom  6*0  to  3'7. 
From  20-25  years  of  age  it  tell  from  7 '2  to  4*6, 
From  25-35  years  of  age  it  fell  from  8*2  to  6 "3. 
From  35-45  years  of  age  it  fell  from  11*6  to  9*9. 
From  45-55  years  of  age  it  fell  from  15*5  to  14*9. 
From  75-85  years  of  age  it  fell  from  133*9  to  133-5. 
And  from  85  and  upwards  it  fell  from  282*1,  the 
average  mortality  over  the  whole  period,  to  259*6 
in  1891-1900.  In  the  age-periods  alone  55-65  and 
65-75  did  the  mortality  rise,  being  in  1838-1900 
28*2  per  1000  from  55-65,  and  29  for  the  ten  years 
ending  in  1900,  while  from  65-75  the  figures  were 
for  1838-1900  59*9,  and  in  1891-1900,  60  per  1000 
per  annum.  This  means  that  with  these  exceptions 
the  average  expectation  of  life  has  been  raised  for 


33 

the  whole  of  the  female  part  of  the  population  of 
England  during  that  long  period  of  time  ;  and  this 
is  certainly  a  very  gratifying  and  satisfactory  state 
of  things,  and  one  for  which  sanitation  and  medical 
progress  may  reasonably  take  credit.  Among  males 
the  same  general  improvement  has  taken  place,  but 
with  differences  not  quite  so  satisfactory  as  regards 
results.  We  find,  for  example,  increased  mortahty 
among  males  for  the  three  age-groups,  45-55,  55-65, 
and  65-75,  in  the  later  and  shorter  period,  as 
compared  with  the  average  of  the  longer  one.  The 
reader  can  see  for  himself  that  at  age-period  45-55 
the  average  mortality  of  males  for  1838-1900  w^as 
19  per  1000  per  annum.  For  1891-1900  it  was 
19 '4  per  1000  per  annum.  At  age-period  55-65 
the  mortality  was  at  the  rate  of  33  "5  per  1000  per 
annum  for  1838-1900,  and  35-8  for  1891-1900; 
and  at  age-period  65-75  it  was  68*1  for  1838-1900, 
as  compared  with  69  for  1891-1900.  On  the  whole, 
however,  both  for  males  and  females,  the  improve- 
ment has  been  very  satisfactory  and  gratifying. 
Some  other  interesting  facts  arise  to  the  student  of 
these  figures.  At  every  age-period  nearly,  the 
mortality  of  males  is  greater  than  that  of  females 
at  the  corresponding  age-periods.  Thus  from  0-5 
years  of  age,  from  5-10  years,  and  at  every  age- 
period  except  from  10-15  and  from  15-20  years  of 
age,  the  mortality  of  males  is  greater  than  that  of 
females.  At  10-15  years  of  age,  however,  and  also 
at  15-20  years,  the  mortality  of  females  living  at 
those  ages  is  greater  than  it  is  for  males.  Thus  for 
c 


u 

1838-1900  the  male  mortality  was  4  per  1000  from 
10-15  years,  and  5  "6  per  1000  from  15-20  years  of 
age,  while  the  corresponding  female  mortality  was 
4'1  per  1000  and  6  per  1000.  For  the  ten  years, 
1891-1900,  the  same  holds  true  for  the  age-period 
10-15,  for  which  the  male  mortality  was  2*4  per 
1000  and  the  female  2*5  per  1000  ;  but  it  does  not 
hold  good  for  age-period  15-20  years,  for  the  male 
mortality  was  at  the  rate  of  3*8  per  1000  per  annum, 
while  the  female  was  3*7.  The  explanation  of  these 
disparities  raises  very  interesting  questions,  but  has 
not  been  wholly  effected.  Certain  broad  facts  rise 
before  the  student  of  these  figures.  While,  for 
instance,  except  at  the  age-periods  already  men- 
tioned, the  expectation  of  life  is  on  the  whole  better 
in  1891-1900  than  it  was  either  on  the  average 
of  1838-1900  or  in  the  ten  years  1841-50,  the 
improvement  is  much  more  noticeable  in  the  early 
life-periods  than  it  has  been  either  in  old  age  or  in 
the  middle  or  working  periods  of  life.  In  the  case 
of  males  from  25  to  45  years  there  has  been  some 
improvement  in  the  expectation  of  life,  which 
means  probably  also  greater  vigour  at  these  ages  to 
do  the  work  of  life,  but,  even  at  the  best,  the 
improvement  has  not  been  very  great.  From  45-75 
the  mortality  is  really  a  little  greater  in  1891-1900 
than  it  was  either  over  the  average  of  the  years 
1838-1900,  or  than  it  was  in  the  years  1841-50. 
Only  from  75  onwards,  when  the  work  of  life 
is  over,  has  the  expectation  of  life  at  the  more 
advanced  ages  been  increased.     We   ought   to  be 


35 

thankful  for  the  improvement  which  has  been 
effected,  but,  when  it  is  all  summed  up,  it  is  not 
yet  so  great  as  we  had  hoped,  or  as  perhaps  the 
prevailing  optimism  in  the  literature  of  the  subject 
had  led  us  to  expect.  The  net  result  appears 
to  be,  in  the  case  of  males,  that  while  in  very 
early  life,  when  work  is  yet  in  promise  rather  than 
performance,  the  expectation  of  life  has  been  very 
considerably  increased;  that  while  in  extreme  old 
age,  when  the  work  of  life  is  over,  and  when  those 
who  have  lived  well  and  have  been  fortunate  may 
sit  down  to  enjoy  the  fruits  of  their  labours,  the 
expectation  of  life  has  also  been  increased ;  in  the 
middle  or  active  periods  of  life,  when  the  burden 
and  heat  of  the  day  have  to  be  borne,  either  the 
expectation  of  life  has  been  only  very  little  increased 
(ages  25-45),  or  it  has  been  even  somewhat 
diminished  (45-75).  Similar  conclusions  arise  from 
a  study  of  the  results  when  lustra  or  quinquennia 
rather  than  decades  are  compared  with  one  another, 
and  with  the  av^erage  results  extending  over  the 
whole  period  from  1838-1900.  The  reader  will 
do  well  to  make  these  comparisons  for  himself. 
Nothing  can  well  afford  a  better  bird's  eye  view,  so 
to  call  it,  of  the  changes  (not  all  progressive, 
unfortunately,  as  regards  the  public  interest)  and 
improvements  which  have  taken  place  in  the  public 
health  since  1838,  than  the  careful  and  prolonged 
study  of  such  a  table.  We  are  at  a  great  advantage 
as  compared  with  our  predecessors  in  the  possession 
of  such  figures,  since  it  makes  our  information,  if 

C2 


36 

not  accurate,  at  least  much  more  approximately 
accurate  than  any  which  our  ancestors  possessed. 
They  were  obliged  to  trust  to  general  impressions, 
while  we  can  adduce  comparative  figures  ;  and  an 
intelligent  attempt  to  realise  on  the  part  of  each 
for  himself  what  has  been  going  on,  coupled  with 
the  appreciation  of  the  fact  that  the  risks  of  males 
from  overwork,  accidents,  anxiety,  and  the  competi- 
tion and  struggle  of  life  generally,  are  considerably 
greater  than  they  are  among  females  (who  yet  have 
their  own  special  risks  and  troubles,  no  doubt),  will 
do  far  more  to  enable  the  student  to  understand 
the  general  question  of  the  improvement  or  other- 
wise in  life  than  any  other  method  of  study. 

If  now  we  come  to  inquire  how  it  is  that  these 
gains  have  been  effected,  the  answer  is  obvious. 
These  changes  and  improvements  are  the  result  of 
the  sanitary  efforts  of  the  present  and  of  the  last 
generation.  We  have  expended  vast  sums  in 
improving  (sometimes  even  in  creating)  drainage 
and  sewage,  in  abolishing  cellar-dwellings,  diminish- 
ing over-crowding,  opening  up  and  widening  narrow 
streets,  opening  public  parks  and  recreation  grounds, 
and  generally  iu  efforts  to  purify  the  air  and  abate 
nuisances ;  and  we  have  obtained  vast  benefits  as 
measured  by  the  figures  just  stated.  Following 
the  statement  of  a  great  sanitarian,  we  have 
believed  and  have  shaped  our  general  national 
hygienic  policy  on  the  statement  that  "  Statistical 
inquiries  prove  beyond  a  doubt  that  of  the  causes 
of  death  which  are  usually  in  action,   impurity  of 


37 

the  air  is  the  most  important."  As  will  abundantly 
appear  in  the  sequel,  this  statement  seems  to  me  to 
be  far  too  sweeping.  It  appears  to  me,  indeed, 
quite  impossible  to  accept  it.  Vitiation  of  air  is  no 
doubt  a  very  important  cause  of  illness  and  of 
death,  but  it  is  not  by  any  means  the  most 
important,  being  second,  and  a  long  way  second, 
to  errors  of  diet.  Whatever  be  its  rank,  however, 
as  a  cause  affecting  health,  there  can  be  no  doubt 
that  attention  to  the  improvement  of  the  air 
breathed  has  had  a  very  great  influence  on  the 
public  health.  Generally  speaking,  the  effects 
having  been  mainly  two,  viz.,  the  diminution  of 
the  incidence  and  of  the  mortality  from  the  fevers 
and  those  from  consumption,  the  general  effect  has 
been  very  much  to  benefit  life  at  the  earlier  ages, 
and  to  diminish  sickness  and  mortality  during  child- 
hood and  youth,  since  the  effects  of  the  zymotic 
diseases  and  of  consumption  are  mainly  felt  at  early 
ages,  the  large  majority  of  these  diseases  occurring 
under  25  years  of  age. 

There  have  been,  however,  at  work  on  the 
health  of  the  community  other  contributory  causes 
besides  those  making  for  the  improvement  of  the 
respired  air.  By  failing  to  realise  the  importance  of 
these,  we  are  apt,  erroneously,  to  attribute  to  sanita- 
tion effects  due  to  other  causes,  so  exaggerating  the 
importance  of  sanitation,  which,  however,  requires 
no  fictitious  aids  to  add  to  its  consequence.  Among 
these  is  the  diminution  which  has  taken  place,  and 
which  appears  to  be  still  going  on,  in  the  birth-rate. 


38 

The  birth-rate  rises  and  falls  under  the  operation  of 
various  causes  connected  with  the  prosperity  or 
otherwise  of  the  people  ;  but,  speaking  broadly,  the 
birth-rate  of  England  and  Wales  was  at  about  3  4 '2 
or  34 "3  per  1000  per  annum  50  years  ago,  and  is 
under  29  per  1000  now,  a  fall  of  about  14  or  15  per 
cent.  This  is  no  isolated  fact  affecting  the  United 
Kingdom  or  England  and  Wales  only.  The  table 
inserted  on  p.  41  from  the  report  of  the  Registrar- 
General  for  England  and  Wales  for  1900  shews  that 
the  diminution  of  the  birth-rate  is  going  on  in 
all  European  countries  without  exception,  even 
Norway  and  Sweden  shewing  the  fall,  although  not 
to  the  same  extent  as  is  seen  elsewhere.  This  is  a 
fact  of  the  utmost  significance,  and  must,  I  think, 
be  considered  as  coincident  with  great  economic  and 
moral  changes  in  the  character  of  peoples.  We  in 
this  country  have  been  accustomed  to  point  to  a 
low  birth-rate  as  a  mark  of  a  people  unexpansive, 
not  given  to  colonisation,  and  somewhat  contracted 
in  their  methods  of  behaviour  and  intellectual 
outlook.  It  is  not  necessary  to  offer  any  opinion 
on  such  views.  Very  much  may  be  said  in  defence, 
as  in  criticism,  of  a  high  birth-rate  on  the  one  hand 
and  of  a  low  one  on  the  other.  The  physician  and 
hygienist  is  happily  not  called  upon  to  defend  or 
blame,  it  being  sufficient  if  he  notes  the  changes 
which  are  occurring  among  the  peoples  whose  health 
he  is  considering,  and  their  influence  upon  it.  The 
noteworthy  fact  is  that  the  process  of  lowering  the 
birth-rate  is  general.    In  France,  it  will  be  observed, 


39 

the  birth-rate  was  in  1900  actually  lower  than  the 
death-rate,  a  fact  which  obtains  in  no  other  European 
country,  and  is  not  even  approximated  to  in  any 
except  Ireland,  whose  latest  returns  make  the  birth- 
rate 22  7  per  1000  and  the  death-rate  19*6.  It  is 
impossible,  I  think,  to  suppose  that  a  tendency 
which  is  seen  in  every  European  country  is  not  of 
grave  moral  significance,  and  I  shall  dismiss  this 
aspect  of  the  question  with  one  observation.  If  a 
diminishing  birth-rate  is,  as  we  imagine  it  to  be, 
a  mark  of  decadence,  or  at  least  of  want  of  pro- 
gressiveness,  as  we  continually  assume  in  comparing 
our  own  country  with  France,  for  example,  it  is  to 
be  noted  that  we  are  persistently  approximating  to 
the  French  custom  in  this  particular.  So  are  all 
European  countries.  In  America,  we  are  told — but 
I  do  not  know  what  the  truth  may  be  in  this 
matter  —  that  but  for  foreign  immigration  the 
numbers  of  the  people  would  not  be  kept  up,  let 
alone  increased,  by  the  excess  of  births  over  deaths. 
It  would  probably  be  a  very  narrow  view  to  assume 
that  these  simultaneous  changes  are  an  imitation  of 
the  French  system.  It  is  far  more  likely  that  the 
causes  are  much  more  general  than  that,  and  that 
they  are  to  be  found  in  changes  in  the  economic 
and  moral  conditions  of  the  various  peoples  con- 
cerned. From  this  (probably  the  correct)  point 
of  view,  the  diminution  in  the  birth-rates  in  the 
various  civilised  countries  ought  rather  to  be 
viewed,  like  the  sequence  of  day  on  night,  as 
concomitant  or  successive  effects  of  a  common  cause 


40 

or  common  causes,  than  as  causes  and  efiects  of  one 
another.  It  is  our  business  to  note  what  are  the 
effects  on  the  health  of  nations  of  a  process  which 
is  so  general  and  so  wide-spread,  that  there  is  not  a 
single  European  country  in  which  a  considerable  fall 
in  the  birth-rate  has  not  occurred  in  the  last  25 
years. 


41 

IHrths  and  Deaths  per  1000  of  the  Poptilation,  in  the  United  Eingdom 
and  in  Other  European  States. 


(Tabulated  from  returns 

furnished  by  the  authorities  of  the  various 

States.) 

Year. 

q 

■<  . 

aj 
c 

a 

< 

H 
O 

< 

m 

l-l 

s 

s 

ft 

o 

a 

w 

< 

H 
to 

< 

o 

a 

o 

2w 

IBS 

■< 

CO 

a 

0H 

O 
Z. 

K 
H 

p 
3 
fa 

H 
o 

M 

Average 

in  the 

26  years 

Births  per  1000  Living. 

1875-99 
1875    ... 

31  •! 

32-3 

32-2 

23-8 

31-3 

30 -V 

28-/ 
31-2 

38'0 

42-9 

28-9 

3V-2 

3V-V 

34-2 

30-1 
32-5 

23-7 

35-6* 

36-6 

33-9 

35-4 

.35-2 

26-1 

,31-9 

31-2 

39-9 

45-0 

32-0 

40-6 

40-7 

36-6 

25-9 

? 

37-7 

1876    ... 

34-8 

36-3 

.35-6 

26-4 

32-6 

31-8 

30-8 

40-0 

46-3 

33-0 

40-9 

40-7 

37-1 

33-2 

26-2 

•) 

39-2 

1877    ... 

34-4 

3ri-0 

.35-3 

26-2 

31-8 

31-8 

31-1 

38-7 

43-6 

32-3 

40-0 

39-9 

36-6 

32-3 

25-5 

? 

37-0 

1878    ... 

34-0 

35-6 

34-9 

25-1 

31-7 

31-1 

29-8 

,38-6 

43-1 

31-6 

38-9 

38-7 

36-1 

31-5 

25.2 

9 

36-2 

1879    ... 

33-3 

34-7 

34.3 

25-2 

32-0 

32-0 

30-5 

39-2 

45-8 

30-8 

38-9 

39-0 

36-7 

31  -5 

25-1 

? 

37-8 

1880    ... 

32-7 

34-2 

33-6 

24-7 

31-8 

30-7 

29-4 

38-0 

42-8 

29-8 

37-6 

37-8 

35-5 

31-1 

24-6 

•) 

33-9 

1881    ... 

32-5 

33-9 

33-7 

24-5 

32-3 

30-0 

29-1 

37-7 

42-9 

30-0 

37-0 

37-0 

35-0 

31-4 

24-9 

1 

38-0 

1882    ... 

32-3 

33-8 

33-5 

24-0 

32-4 

30-9 

29-4 

39-1 

43-8 

29-1 

37-2 

37-6 

35-3 

31-2 

24-8 

•> 

37-0 

1883    ... 

32-0 

33 -.5 

32-8 

23-5 

3T8 

30-9 

28-9 

38-2 

44-8 

28-8 

36-6 

37-1 

34-3 

30.5 

24-8 

9 

37-1 

1884    ... 

32-2 

33-6 

33-7 

23-9 

33-4 

31-0 

30-0 

38-7 

45-6 

28-5 

37-2 

37-6 

34-9 

30-5 

34-7 

V 

38-9 

1885     ... 

.SI -6 

,S2.9 

32-7 

23-5 

32-6 

31-3 

29-4 

37-6 

44-8 

28-0 

37-0 

37-7 

.34-4 

29-9 

24-3 

9 

38-4 

1886    ... 

31-5 

32-8 

32-9 

23-2 

32-6 

30-9 

29-8 

38-0 

45-6 

28-0 

37-0 

37-7 

34-6 

29-6 

23-9 

? 

36-8 

1887     .. 

30-7 

31-9 

31-7 

23-1 

32-0 

30-8 

29-7 

38-2 

44-2 

28-0 

36-9 

37-7 

33-7 

29-4 

23-5 

9 

38-8 

1888    ... 

30-1 

31-2 

.3T3 

22-8 

3T7 

30-8 

28-8 

37-9 

43-8 

27-8 

36-6 

37-4 

33-7 

29-1 

23-1 

36-6 

37-4 

1889    ... 

30.0 

,Sl-2 

30-9 

22-7 

3T3 

29-7 

27-7 

37-9 

42-7 

27-6 

36-4 

37-1 

33-2 

29.6 

23-0 

3fi-7 

38-1 

1890    ... 

29-2 

30-2 

30-4 

22-3 

30-6 

30-3 

28-0 

36-7 

40-3 

26-4 

35-7 

36-6 

32-9 

28-7 

21-8 

34-8 

35-7 

1891    ... 

30-4 

3T4 

3T2 

23-1 

30-9 

30-9 

28-3 

37-0 

42-3 

27-8 

.37-0 

37-7 

33-7 

29-6 

22-6 

35-8 

37-0 

1892    ... 

29-5 

30-4 

30-7 

22-5 

29-5 

29-6 

27-0 

36-2 

40-4 

27-4 

35-7 

36-3 

32-0 

28-9 

22-3 

36-4 

36-1 

1893    ... 

29-8 

30-7 

30-8 

23-0 

30-5 

30-7 

27-4 

37-9 

42-6 

27-7 

36-8 

37-5 

33-8 

29-5 

22-3 

36-1 

36-4 

1894    ... 

28-8 

29-6 

29-9 

22-9 

30-1 

29-8 

27-1 

36-7 

41-5 

27-1 

35-9 

.36-6 

32-7 

29-0 

22-3 

.35-3 

35-4 

1895    ... 

29-4 

30-2 

30-0 

23-2 

30-0 

30-6 

27-5 

38-1 

41-9 

27-1 

36-1 

36-9 

32-8 

28-5 

21-7 

35-4 

34-7 

1896    ... 

29-0 

29-6 

30-4 

23-6 

30-3 

30-4 

27-2 

38-0 

40-5 

27-9 

36-3 

36-9 

32-7 

29-0 

22-5 

.36-3 

34-7 

1897     ... 

28-9 

29-5 

30-0 

23-5 

29-7 

30-0 

26-7 

37-5 

40-3 

28-1 

36-0 

.36-5 

.32-5 

29-0 

22-3 

34-6 

34-6 

1898    ... 

28-7 

29-3 

30-1 

23-2 

30-2 

30-3 

27-1 

36-2 

37-7 

38-4 

36-1 

36-7 

31-9 

28-6 

21-8 

33-8 

33-4 

1899    ... 

28-5 

29-1 

29-8 

22-9 

29-8 

30-9 

26-4 

37-1 

39-3 

28-9 

35-8 

36-3 

32-0 

28-8 

21-9 

,34-8 

33-8 

1900    ... 

28-2 

28-7 

29-6 

22-7 

29-8 

30-1 

26-9 

39-3 

28-6 

35-6 

36-1 

31-5 

28-9 

21-4 

34-4 

32-9 

Average 

Deaths  pe 

R     1000    LiVIN    . 

in  the 

25  years 

1875-99 

19-1 
22-1 

19-3 

19-4 

18-1 

18-6 

16-7 

17-1 
20-3 

28-8 

32-7 

20-8 

24-4 

23-9 
26-6 

20-6 

20-3 

22-0 

30-4* 

26-7 

1875    ... 

22-7 

23-3 

18-5 

21-0 

18-8 

30-0 

.37-0 

24-2 

27-6 

25-6 

22-7 

23-0 

9 

.30-7 

1876    ... 

20-4 

20-9 

20-9 

17-3 

19-7 

18-0 

19-6 

29-8 

.35-9 

24-3 

26-3 

25-4 

23-5 

21-9 

22-6 

? 

28-8 

1877    ... 

19-9 

20-3 

20-6 

17-5 

18-7 

16-9 

18-7 

31-6 

36-6 

23-6 

26-4 

25-6 

22-2 

21-1 

2T6 

9 

28-3 

1878    ... 

21-1 

21-6 

21-2 

18-6 

18-5 

15-8 

18-1 

31-6 

37-4 

23-5 

?.6-2 

25-8 

23-0 

21-5 

22-5 

9 

29-1 

1879    ... 

20-5 

20-7 

20-0 

19-6 

19-8 

15-0 

16-9 

29-9 

.35-7 

22-7 

2.') -6 

24-7 

22-5 

21-9 

22-5 

? 

29-8 

1880    ... 

au-4 

20-5 

20-6 

19-8 

20-4 

15-9 

18-1 

29-8 

37-2 

22-0 

26-0 

25-5 

23-5 

22-3 

22-9 

9 

30-8 

1881    ... 

18-7 

18-9 

19-3 

17-5 

18-3 

16-8 

17-7 

30-6 

34-4 

22-6 

25-5 

24-9 

21-5 

20-9 

22-0 

9 

27-6 

1882    ... 

19-3 

19-6 

19-4 

17-3 

19-3 

18-4 

17-4 

30-8 

35-3 

22-2 

25-7 

25-4 

20-7 

20-2 

22.2 

9 

27-5 

1883    ... 

19-6 

19-6 

20-2 

19-2 

18-4 

17-1 

17-3 

,30-1 

32-2 

20.6 

25-9 

25-6 

21 -8 

20-8 

22-2 

? 

27-5 

1884    ... 

19-4 

19-7 

19-6 

i7-5 

18-4 

16-4 

17-5 

29-4 

.31-0 

20-4 

26-0 

25-7 

22-2 

20-9 

22-6 

9 

26-8 

1885    ... 

19-1 

19-2 

19-3 

18-4 

17-9 

16-5 

17-8 

.30-1 

.3T8 

21-4 

25-7 

25-4 

2T0 

20-1 

22-0 

? 

26-9 

1886    ... 

19-2 

19-5 

18-9 

17-8 

18-2 

16-1 

16-6 

29-4 

.3T7 

20-8 

26-2 

26-1 

21-8 

21  1 

22-5 

? 

28-6 

1887    ... 

19-0 

19-1 

19-0 

18-2 

18.3 

16-0 

16-1 

28-9 

,33-8 

20-3 

24-2 

23-8 

19-7 

19-3 

22-0 

? 

27-9 

1888    ... 

18-1 

18-1 

18-0 

17-9 

19-7 

16-9 

16-0 

29-2 

32-0 

20-0 

23-7 

22-8 

20-4 

20-1 

21-9 

30-3 

27-4 

1889    ... 

18-1 

18-2 

18-4 

17-4 

18-6 

17-4 

16-0 

27-3 

29-9 

20-0 

23-7 

23 '2 

20-1 

19-1 

20-7 

30-9 

25-5 

1890    ... 

19-4 

19-5 

19-7 

18-2 

19-0 

17-9 

17-1 

29-4 

32-4 

20-8 

24-4 

24-0 

20-5 

20-6 

22-8 

.32-7 

26-2 

1891    ... 

20-0 

20-2 

20-7 

]8-4 

20-0 

17-5 

16-8 

28-2 

33-1 

20-4 

23-4 

22-9 

20-7 

21-0 

22-9 

.32-0 

26-0 

1892    ... 

19-0 

19-0 

18-5 

19-4 

19-4 

17-8 

17-9 

28-8 

35-1 

18-8 

24-1 

23-4 

21-0 

21-8 

22-8 

31 -3 

26-1 

1893    ... 

19-0 

19-1 

19-3 

17-9 

18-8 

16-3 

16-8 

27-2 

31-2 

19-9 

24-6 

24-2 

19-2 

20-3 

22-5 

30-3 

25-1 

1894    ... 

16-8 

16-6 

IV -1 

18-2 

17-4 

16-9 

l(J-4 

27-8 

30-5 

19-9 

22-3 

21-8 

18-5 

18-6 

2T2 

,31-1 

24-9 

1895    ... 

18 -V 

18 -V 

19-4 

18-4 

16-8 

15-7 

15-2 

27-7 

29-7 

19-] 

22-1 

21-8 

18-6 

19-5 

22-2 

29-4 

25-0 

1896    ... 

17-0 

IV -0 

16-6 

16-6 

15-6 

15-2 

15-6 

26-4 

2,S-9 

17-7 

20-8 

20-7 

17-2 

17-5 

20-0 

29-9 

24  0 

1897     ... 

17-6 

IV -4 

18-4 

18-4 

16-5 

15-3 

15-4 

25-6 

28-5 

17-6 

2T3 

20-9 

16-9 

17-2 

19-6 

28-8 

21-9 

1898    ... 

IV -6 

17-5 

18-0 

18-1 

15-5 

15-3 

15-1 

24-9 

28-0 

182 

20-5 

20-0 

17-0 

17-6 

20-9 

28-6 

22-9 

1899    ... 

18-2 

18-2 

18-1 

17-6 

17-3 

16-9 

17-7 

25-4 

27-2 

17-6 

2Tfi 

21-4 

17-1 

18-8 

21-1 

29-3 

21-8 

1900    ... 

18-4 

18-2 

18-5 

19-6 

16-9 

15-8 

16-8 

— 

26-9 

19-3 

22-1 

21-8 

17-8 

19-3 

21-9 

29-4 

28-7 

'■  Average  of  12  years— 1888-! 


wmm 


^MHaWdHaUlin 


42 

There  is  one  great  fact,  however,  brought  out 
prominently  by  a  study,  however  brief,  of  this 
table.  High  birth-rates  as  a  rule  accompany  high 
death-rates,  and  low  birth-rates  low  death-rates  ; 
and  to  a  large  extent  these  are  cause  and  effect  of 
one  another.  In  Austria  and  Hungary  the  birth- 
rates, though  falling,  are  still  higher  than  in  any 
other  European  country  (37  and  39  per  1000),  and 
their  death-rates  are  also  the  highest  (25*4  and  27'2 
in  1899).  The  statistics  of  Spain  form  an  exception, 
but  apparently  the  figures  are  not  so  full  or  accurate 
as  for  other  European  countries.  And  the  reason 
why  birth-rates  and  death-rates  are  not  only 
casually,  but  also  causally  connected,  is  this. 
There  is  unfortunately  a  very  large  mortality  pro- 
portionately at  the  early  ages  of  life.  Of  1,000,000 
male  children  born  over  the  average  of  the  ten 
years  1881-90,  only  760,167  would  be  found  sur- 
viving at  the  end  of  five  years  or  under  five  years 
of  age.  For  females  the  number  sm^viving  would 
be  791,973.  Boughly  speaking,  about  one-fourth  of 
the  children  born  die  in  the  fii'st  five  years  of  life. 
In  the  first  year  of  life,  out  of  1,000,000  males  born 
161,036,  or  161  per  1000,  died  over  the  average  of 
the  ten  years  1881-90.  For  female  children  the 
corresponding  number  was  found  to  be  131,126,  or 
131  per  1000.  Now  a  lowered  and  a  lowering 
birth-rate,  such  as  we  see  to  have  been  going  on 
over  a  number  of  years  past,  means  that  a  smaller 
proportion  of  the  population  are  alive  at  the  more 
fatal   ages  than  when   the   birth-rate  was   higher. 


43 

And  this  being  so,  a  lowered  birth-rate  implies  a 
lowered  death-rate,  even  if  no  sanitary  improve- 
ments take  place  in  the  condition  of  the  people. 
When,  therefore,  we  compare,  as  we  often  have 
occasion  to  do,  the  hygienic  and  sanitary  conditions 
of  one  set  of  people  with  another,  or,  say,  the  health 
conditions  of  one  town  with  another,  we  shall  be 
omitting  a  very  important  factor  if  we  do  not  take 
account  of  differences  in  the  birth-rate  of  the 
towns.  For  the  curious  thing  is  that  there  often 
exist  such  differences  even  in  towns  quite  near  to 
one  another.  The  fall  in  the  birth-rate  has  been,  as 
we  have  seen,  continuous  in  England  and  Wales  for 
many  years  past.  But  this  fall,  though  applying 
generally  to  the  country  and  to  the  United  Kingdom, 
is  much  more  accentuated  in  some  places  and  in 
some  parts  of  the  country,  and  notably  in  some  of 
the  boroughs,  than  others.  This  is  more  marked  in 
the  West  Riding  of  Yorkshire,  e.  g. ,  than  in  London. 
In  Bradford  the  birth-rate  is  the  lowest,  and  that 
by  a  good  deal,  of  all  the  large  towns  (with  popula- 
tions of  200,000  and  over)  in  the  United  Kingdom ; 
and  its  birth-rate  has  been  persistently  falling  for  a 
long  time.  Thus  in  1881  it  was  33  per  1000;  in 
1885  it  was  29;  in  1891  it  was  28'6;  in  1895  it 
was  26 '6  ;  in  1900  it  was  24*6  ;  and  in  1901  it  was 
28  "1.  In  Leeds,  only  nine  miles  away,  the  birth-rate 
in  1901  was  30  per  1000;  in  Sheffield,  33-1;  in  Hull, 
33*3  ;  and  in  Newcastle,  32-1.  All  these  towns 
have  populations  of  over  200,000,  and  Bradford's 
birth-rate   is  considerably  lower  than  that  of  any 


44 

of  them.  Only  in  Halifax  and  Huddersfield,  of 
Yorkshire  towns,  each  with  populations  of  about 
100,000,  is  the  birth-rate  lower  than  in  Bradford, 
being  22*5  and  22*7  in  1901  respectively.  In 
London  in  the  same  year  it  was  29,  while  the 
average  of  thirty-two  provincial  English  towns  was 
29  "8.  The  low  birth-rates  of  some  of  the  West 
Riding  of  Yorkshire  manufacturing  towns  of  late 
years  is  a  curious  and  interesting  fact. 

A  low  birth-rate  implies  a  low  death-rate,  and 
a  high  birth-rate  implies  a  high  death-rate.  It 
might  be  argued,  and  probably  with  truth,  that 
more  care  would  have  prevented  a  large  proportion 
of  the  deaths  that  occur  among  infants  and  young 
children.  Even  with  a  low  birth-rate,  in  some 
places  the  infant  mortality  is  high.  In  Bradford  in 
the  ten  years  ending  in  1900  the  death-rate  of 
infants  under  one  year  of  age  averaged  171  out  of 
every  1000  born,  and,  as  we  have  seen,  the  birth- 
rate is  very  low.  Whatever  the  causes  of  this 
may  be,  wheresoever  a  low  birth-rate  and  a  high 
infantile  mortality  rate  coincide,  that  portion  of  the 
population  has  laid  on  it  the  burden  of  accounting 
for  the  coincidence,  and  of  shewing  that  it  is  not 
due  to  negligence.  It  is  quite  compatible  with  the 
view  taken  by  the  writer  of  this  essay  that  the 
most  important  cause  of  mortality  in  general  is 
wrong  feeding,  to  note  what  Dr.  Arnold  Evans, 
the  Medical  Officer  of  Health  for  Bradford,  says 
regarding  the  high  infantile  mortality  in  that  city. 
"The  high  infantile  mortality,"  he  says  in  his  report 


45 

for  1901,  "is  not  to  any  great  extent  the  result  of 
the  employment  of  women  in  factory  work,  but  I 
am  sure  it  is  largely  contributed  to  by  a  wide-spread 
ignorance  of  the  management  and  feeding  of  infants 
among  the  working  classes.  In  the  returns  pre- 
pared by  the  Inspector,  such  expressions  as  '  fed  by 
breast  for  two  months,  and  afterwards  on  Quaker 
Oats  and  lime  water,'  or  '  pobbies,'  are  not  uncom- 
mon ;  some  infants  were  fed  on  all  kinds  of  malted 
food,  and  one  infant,  which  died  at  the  age  of  ten 
months,  and  commenced  life  on  humanised  milk,  was 
afterwards  fed  on  '  Marshall's  Malted  Food,  Scott's 
Emulsion,  and  brandy  and  cream,'  and  towards  its 
end  on  'veal  and  tea.'"  In  order  to  meet  this 
deplorable  state  of  things  he  recommends  the 
establishment  of  "  municipal  milk  depots,  where 
humanised  milk  may  be  obtained  in  amounts  suit- 
able for  infants  of  various  ages,  and  as  cheaply  as 
it  can  be  produced."  Information  as  to  the  proper 
methods  of  feeding  infants,  and  the  quantities  and 
times  for  administration  of  their  food,  would  also 
be  greatly  for  the  benefit  of  the  public  health,  since 
even  suitable  food  may  be  administered  too  often  or 
too  seldom.  As  a  rule,  however,  it  must  be 
admitted,  when  all  has  been  done,  that  the  rearing 
of  young  children,  like  the  rearing  of  young 
animals  of  all  sorts,  is  a  task  accompanied  by  many 
difficulties,  and  even  when  much  and  continuous 
care  has  been  exercised,  some  amount  of  failure  is 
apt  to  be  experienced.  No  doubt,  many  sensible 
and  careful  and  well  advised  mothers  rear  all  their 


46 

children,  but  we  are  struck  with  the  reflection  that 
some  or  many  others  must  be  careless,  ignorant  or 
incapable,  or  through  economic  or  other  causes  may 
find  the  task  beyond  them,  when  we  realise  that 
about  a  quarter  of  all  the  children  born  in  this 
country  die  before  they  are  five  years  of  age.  In 
England  and  Wales  in  1900,  209,960  deaths  out  of 
a  total  of  587,830  occurred  among  children  under 
five  years  of  age.  That  was  about  36  per  cent.  In 
many  years  two-fifths  or  40  per  cent,  of  the  total 
mortality  has  been  returned  as  occurring  among 
children  under  five  years  of  age.  In  1893,  for 
instance,  569,958  deaths  occurred  in  England  and 
Wales,  and  of  these  216,833,  or  very  nearly  two- 
fifths  or  40  per  cent.,  occurred  among  children  under 
five  years  of  age.  As  in  many  of  the  towns  the 
proportion  is  the  same,  we  can  see  how  important  an 
influence  such  a  fact  must  exert  on  the  general 
mortality  returns.  But  about  25  per  cent,  of  all 
the  children  born  die  before  they  are  five  years  of 
age.  If,  therefore,  a  smaller  number  of  children  are 
born  into  the  world  than  formerly  (and  that  is  the 
meaning  of  a  low  birth-rate),  obviously  there  will 
be  a  smaller  number  of  the  population  living  to 
afibrd  so  high  a  mortality,  and,  therefore,  the 
general  mortality  rate  will  prove  lower,  not  only 
because  of  general  improvement  in  the  public 
health,  but  also  because  a  smaller  proportion  of  the 
population  are  living  at  what  may  be  termed  the 
very  fatal  ages.  An  illustration  will  make  this 
clear.     Suppose  a  town  of  200,000  inhabitants  has 


47 

a  birth-rate  of  30  per  1000,  whereas  formerly  it  had 
a  birth-rate  of  35.  Obviously  6000  children  will  be 
born  where  7000  used  to  be ;  that  is,  1000  fewer 
children  will  be  living  in  that  town  under  the  new 
birth-rate  than  under  the  old  one  during  a  given 
year.  Now  suppose  that  one-fifth  of  the  children 
born  died  under  one  year  old  (which  rate,  I  regret 
to  say,  is  not  only  reached  but  even  occasionally 
exceeded  in  some  of  our  large  towns),  then  1200 
children  would  die,  as  against  1400,  had  the  former 
birth-rate  been  maintained.  This  would  reduce  the 
deaths  by  200  in  a  year,  or  1  per  1000  per  annum 
in  a  population  of  200,000,  a  diminution  quite 
sufficiently  marked  to  seem  to  justify  the  statement 
that  that  town  was  at  a  higher  level  of  health  than 
others. 

Another  point  should  not  be  lost  sight  of  A 
large  proportion  of  all  the  cases  of  fever  that  occur, 
a  large  proportion  of  the  zymotic  diseases  as  they 
are  called,  happen  among  children  under  five  years 
of  age  —  a  large  number  of  cases  of  measles, 
scarlatina,  diphtheria,  diarrhoea,  &c.  Now,  as  under 
a  lower  birth-rate  a  smaller  number  of  persons 
specially  susceptible  to  these  ailments  are  living  at 
a  given  time,  it  follows  that  fewer  of  these  cases 
will  occur,  and  therefore  that  a  lowered  birth- 
rate lowers  not  only  the  general  mortality  as  we 
have  seen,  but  that  it  lowers  also  the  zymotic  or 
fever  mortality.  But  the  lowering  of  the  zymotic 
mortality  is  almost  by  every  writer  pointed  to  as 
marking    the    general    sanitary    advance    of    the 


48 

country.  From  the  considerations  advanced,  how- 
ever, it  is  apparent  that  this  is  not  necessarily  so, 
that  a  mere  diminution  of  mortahty  is  not  in  itself 
necessarily  a  mark  of  improvement  in  the  public 
health,  that  a  mere  diminution  even  in  the  mortality 
from  fever  may  be  capable  of  other  explanation, 
and  that  many  corrections  may  have  to  be  made 
before  we  are  in  a  position  to  estimate  justly  the 
state  of  the  public  health  as  shewn  in  the  mortality 
returns  of  the  Registrar-General  or  in  those  of  local 
Medical  Officers  of  Health. 

For  some  reason,  not  apparent  on  the  surface, 
the  mortality  among  infants  under  one  year  of  age 
has  not  improved  as  compared  with  the  mortality  at 
other  ages  in  recent  years.  Comparing  the  ten 
years  1881-90  with  1871-80,  we  find  the  mortality 
for  male  infants  under  one  year  was  161,036  per 
million,  or  161  per  1000,  in  1881-90,  as  compared 
with  158  per  1000  in  1871-80.  For  females  the 
corresponding  numbers  were  131  in  1881-90,  as 
against  129  in  1871-80.  For  1900  the  infant 
mortality  in  England  and  Wales  for  both  sexes 
was  154  per  1000.  Various  suggestions  occur  to 
account  for  this  somewhat  remarkable  fact.  Under 
five  years  of  age,  on  the  other  hand,  the  improve- 
ment has  been  considerable,  whether  we  compare 
1881-90  with  1871-80  or  with  the  average  of  the 
years  1838-54.  For  females  the  mortality  under 
five  years  of  age  was  :— For  1881-90,  208  per  1000  ; 
for  1871-80,  224  ;  and  for  1838-54,  236.  For  males 
the    rates    were    240,    253    and    263    respectively, 


49 

shewing  a  progressive  diminution  of  mortality  since 
registration  began  in  England  and  Wales. 

We  have  seen  that  209,960  out  of  587,830,  or 
about  36  per  cent.,  of  the  deaths  which  occurred  in 
England  and  Wales  in  1900,  were  of  children  under 
five  years  of  age.  On  the  other  hand,  142,496 
deaths,  or  about  24  per  cent.,  occurred  among 
persons  over  65  years  of  age.  That  leaves  235,374 
deaths,  or  about  40  per  cent.,  as  the  number  and 
proportion  of  deaths  which  occurred  between  five 
and  65  years  of  age.  I  take  this  number  as  it 
gives  the  proportion  of  deaths  which  occurred  at 
■what  may  be  considered  the  active  or  working 
period  of  hfe.  The  nuiiiber  of  the  active  popula- 
tion is  indeed  not  so  large  as  this,  for  before  15-20 
years  we  can  scarcely  reckon  school  children  among 
the  active  working  members  of  the  community. 
But  from  five  to  fifteen  years  of  age  mortality  is 
very  low,  and  so  I  have  for  convenience  taken  the 
40  per  cent,  of  mortality  which  occurs  between  five 
and  65  years  of  age  into  consideration  as  a  whole. 
Of  what  did  these  235,374  persons  die  ?  Of  course 
a  preliminary  question  is  why  did  they  die  at  all  ? 
If  children  pass  through  the  dangers  which  beset 
them  under  five  years  of  age,  why  should  they  not 
reach  old  age  ?  Why  at  least  should  they  not  over- 
pass 65  years,  if  it  is  too  much  to  hope  that  they 
should  reach  the  three  score  years  and  ten  usually 
considered  as  the  term  of  human  life  ?  It  is  for 
medicine  to  say  why.  Of  course  some  accidents 
must  be  expected  to  occur.     We  cannot  hope  that 

D 


60 

the  whole  population  over  five  years  of  age  should 
reach  old  age  or  even  65  years  of  age,  although  to 
take  65  years  instead  of  70  is  to  make  easier  the 
problem  of  medicine  by  five  years  of  life.  Let  us 
assume  that  for  various  reasons,  delicacy,  for 
example,  accident,  and,  in  one  word,  unsuitability 
of  environment,  20  per  cent,  or  one-fifth  of  these 
235,274  persons  should  fail  to  reach  the  age  even 
of  65  years.  That  would  still  leave  188,300  deaths 
as  occurring  in  England  and  Wales  in  1900  between 
five  and  65  years  of  age,  who  might  reasonably 
have  been  expected  to  reach  it.  As  to  accident 
itself  as  a  cause  of  mortality  we  do  not  find  that  it 
is  an  increasing  factor.  Legislation  has  been  active 
in  this  direction  as  well  as  in  others  in  defence  of 
public  health ;  and  in  compulsory  fencing  of 
machinery,  defence  from  dangerous  places,  com- 
pensation for  injury  sustained  in  the  prosecution 
of  daily  occupations,  and  in  other  ways,  has  taken 
what  steps  it  could  in  the  way  of  preventing  death 
from  accident  and  violence.  I  do  not  know  that 
much  stress  need  be  laid  on  the  figures,  and  there  is 
no  need  to  do  so  ;  but  so  far  as  can  be  made  out 
there  is  no  increase  of  mortality  under  the  heading 
of  accident  among  the  people  of  England.  Thus 
the  deaths  returned  as  from  accident  in  1868  were 
in  the  proportion  of  30,867  to  1,000,000  deaths  from 
all  causes,  while  in  1893,  a  quarter  of  a  century 
afterwards,  they  were  at  the  rate  of  29,615  to 
1,000,000  deaths  from  all  causes.  In  1900  the 
proportion   was    30,567.      There  is   no   increase   of 


51 

mortalitv  from  this  cause.  From  1866-70  the 
deaths  from  accident  or  neghgence  were  at  the  rate 
of  677"8  per  miUion  Hving ;  in  1876-80  the  rate  was 
630-4;  in  1886-90  it  was  543-8;  and  in  1896-1900 
it  was  557 "8.  Still,  if  death  from  accident  and 
violence  is  not  increasing,  but  if  anything  diminish- 
ing in  the  country  (and  after  all  accident  is  a 
comparatively  small  cause  of  mortality),  it  will  be 
interesting  to  inquire  what  are  the  principal  causes 
of  mortality  in  the  population,  especially  at  the 
middle  or  active  portion  of  life.  This  I  propose  to 
do  in  the  next  chapter.  Meantime,  if  we  attempt 
to  sum  up  the  results  of  improved  medicine  and 
surgery  since  the  year  1838,  when  the  Registrar- 
General  began  to  compile  the  figures  for  England 
and  Wales,  they  appear  to  be  the  following.  The 
fevers  or  zymotic  diseases  have  fallen  to  about  one 
half,  and  consumption  by  more  than  one  half  in 
their  incidence  and  mortality  during  that  time. 
These  two  great  and  very  satisfactory  results  are 
aided,  however,  by  a  considerable  fall  in  the  birth- 
rate, and  the  three  factors  account  for  a  diminution 
in  the  general  death-rate  of  about  20  per  cent, 
since  1838.  The  expectation  of  life  has  risen  in  the 
case  of  males  from  39*91  years  to  43*66  years,  and 
in  the  case  of  females  from  41*85  years  to  no  less 
than  47*18  years,  and  an  immense  number  of  years 
of  life  amounting  to  many  millions  have  been  added 
to  the  population  in  each  generation.  The  addition, 
however,  has  been  made  rather  at  the  two  extremes 
of  Ufe,  children  under  20,  and  old  persons  over  65, 

D2 


52 

having  benefitted  much  more  than  those  Hving 
between  25  and  65  years  of  age.  The  expectation 
of  Ufe  has  been  raised  in  the  case  of  females  at  all 
ages  except  from  about  65-75,  and  for  males  except 
from  45  to  75  years  of  age ;  rather  important 
exceptions,  however.  Keeping  these  changes  and 
improvements  in  our  minds,  we  shall  be  better  able 
to  estimate  their  causes,  after  examining  the  causes 
of  mortality  from  five  to  65  years  of  age,  as  is  now 
to  be  done. 


63 


CHAPTEE    II. 


The  Principal  Causes  of  Mortality  in  England 
and  Wales. 


TN  1900,  in  England  and  Wales,  the  most  frequent 
cause  of  death,  taking  the  whole  population  at 
all  ages,  was  bronchitis.  It  accounted  for  54,580 
deaths  out  of  the  587,830  occurring  in  that  year. 
This  is  no  unusual  proportion,  as,  year  after  year, 
bronchitis  heads  the  list  among  the  causes  of 
mortality.  In  1899  bronchitis  accounted  for  51,206 
deaths;  in  1898,  for  46,261;  and  so  on.  If  we 
calculate  the  proportion  of  deaths  occurring  from 
this  cause  to  a  million  deaths  from  all  causes,  we 
shall  find  that  in  1900  bronchitis  accounted  for 
mortality  in  the  proportion  of  92,850  deaths  out  of 
each  million  that  occurred.  This  is  usually  called 
the  proportional  number,  and  it  may  be  well  to 
make  use  of  this  expression.  The  next  commonest 
cause  of  death  is  pneumonia  or  inflammation  of  the 
lungs ;  single  pneumonia  when  only  one  lung  is 
inflamed,  double  when  both  are  affected.  The 
number  of  deaths  that  occurred  from  pneumonia  in 
England  and  Wales  in  1900  was  44,300,  and  the 
proportional  number  was  75,362.  Between  them, 
these  two   diseases   accounted   for   at   the   rate  of 


54 

168,212  deaths  out  of  every  million  of  deaths  that 
occurred.  These  diseases  are  generally  said  to  be 
due  to  cold.  No  doubt  exposure  to  cold  is  very 
often  the  immediate  exciting  cause  of  them.  But 
there  is  very  strong  reason  to  believe — and  I  hope 
to  be  able  to  adduce  probable  if  not  even  demon- 
strative evidence  to  this  effect  —  that  not  only 
these  diseases,  but  many  others  also,  have  their 
predisposing  causes  in  errors  of  diet.  "  How  few 
diseases,"  says  Professor  Stewart  in  his  Manual  of 
Physiology,  "  are  not  in  some  degree  alimentary." 
As  to  the  opinion,  however,  that  bronchitis  and 
pneumonia  are  due  to  exposure  of  the  body  to  cold, 
it  must  be  said  that  these  affections  are  not  by  any 
means  experienced  only  in  cold  weather.  Patients 
often  suffer  from  severe  attacks  of  them  also  in 
summer.  The  true  statement  regarding  the  effects 
of  heat  and  cold  in  inducing  these  diseases  would 
be,  I  suppose,  that,  in  those  predisposed  to  them, 
cold  is  often  the  exciting  cause,  and  so  is  heat,  but 
that  without  the  predisposition  neither  cold  nor 
heat,  at  least  in  the  moderate  amounts  of  them 
experienced  in  ordinary  life  in  England,  would 
induce  them.  Humanity  is  intended  and  fitted  to 
endure  without  damage  moderate  changes  both  in 
heat  and  cold.  And  predisposition  to  disease — - 
what  is  that  ?  Predisposition  is  inverse  resistance  ; 
it  is  weakness ;  and  it  can,  I  think,  in  the  large 
majority  of  cases,  be  defined  in  terms  of  the 
influence  on  the  economy  of  air,  food,  and  exercises 
or  movements.     What  is  meant  bv  that  statement 


55 

is  this.  If  the  economy  is  treated  by  a  proper 
amount  of  food,  neither  too  Httle  nor  too  much  ;  if 
the  air  suppHed  to  it  is  moderately  pure  and 
abundant ;  and  if  exercises  or  movements  of  the 
body  are  properly  followed,  neither  over-exercise  nor 
under-exercise  being  indulged  in,  then  the  predis- 
position of  the  body  to  disease  will  be  found  to  be 
greatly  lessened,  or  otherwise  the  resistance  to 
disease  will  be  greatly  increased.  If,  on  the  other 
hand,  the  body  has  either  too  much  food  or  too 
little  ;  if  the  air  breathed  is  impure  and  in  excess 
or  deficiency ;  and  if  the  muscular  movements  used 
are  too  few  or  too  many,  then  the  predisposition  of 
the  body  to  disease  will  be  found  to  be  greatly 
increased,  or  otherwise  its  resistance  will  be  greatly 
diminished.  Predisposition  is  inverse  resistance ; 
the  greater  the  predisposition  the  less  the  resistance, 
and  the  less  the  predisposition  the  greater  the 
resistance  to  outside  influences.  Heat  and  cold  are 
of  course  relative  terms.  If  heat  is  assumed  to  be 
the  positive  condition,  then  cold  is  only  a  less 
amount  of  heat,  so  that  exposure  to  heat  and  cold 
only  means,  when  we  think  about  it,  exposure  to 
more  heat  or  to  less  heat.  It  might  be  thought 
that  "  cold  "  might  be  defined  as  a  degree  of  heat 
less  than  the  normal  temperature  of  the  body ;  but 
if  this  were  so,  then  we  should  be  obliged  to  say 
that,  in  the  English  climate  at  all  events,  the 
weather  is  almost  always  cold,  because  the  tempera- 
ture of  the  air  is  very  rarely  indeed  so  high  as 
98*4°F.     In  hydropathic  establishments,  and  in  some 


56 

of  the  literature  appertaining  thereto,  the  term 
"  cold "  is  applied  to  water  of  a  temperature  of 
60°¥.  or  less.  We  are  quite  unable  to  alter  our 
climate  ;  we  may  have  a  change  of  climate,  indeed, 
that  is  a  few  of  us  can,  very  few  comparatively ; 
but  we  are  sometimes  well,  and,  on  the  other  hand, 
sometimes  ill,  in  all  kinds  of  weather,  so  that  it  is 
not  the  weather  only  which  affects  us,  a  more 
important  factor  being  the  state  we  are  in,  or  the 
predisposition  of  the  body  to  disease.  But  to  say 
that  a  man  was  specially  predisposed  to  any  disease,  to 
bronchitis,  for  example,  or  pneumonia,  is  equivalent 
to  saying  that  his  resistance  was  so  low  that  an 
amount  of  exposure  less  than  would  have  been 
necessary  in  the  case  of  another  man  sufficed  to 
induce  in  him  an  attack  of  bronchitis  or  of 
pneumonia.  But  in  reference  to  this,  the  important 
point  to  get  into  our  minds,  and  to  keep  there, 
is  that  predisposition  can  be  altered  by  changes 
effected  between  the  organism  and  its  environment, 
and  particularly  by  alterations  in  the  food  habits. 
No  doubt  alterations  of  the  environment  in  other 
particulars  also  have  their  influence.  It  is  well- 
known  that  through  accustoming  oneself  to  cool 
baths,  to  open  windows,  and  to  moderate  and  well 
regulated  exercises,  the  resistance  of  the  body  to 
disease  can  be  greatly  increased,  or,  in  other  words, 
that  its  predisposition  to  disease  can  be  greatly 
lessened.  But  while  this  is  so,  no  doubt,  the 
chief  means  by  which  predisposition  to  disease 
can    be    lessened    seems    to    consist    in    a    proper 


57 

arrangement  of  the  dietary,  so  that  neither  too 
much  nor  too  Httle  is  taken.  How  much  that 
is,  and  how  often  it  ought  to  be  administered, 
attempts  will  be  made  to  state  later.  Meantime,  it 
should  be  stated  that,  as  has  been  said  long  ago,  the 
quantity  and  kinds  of  food,  and  the  proper  times 
for  taking  it,  cannot  be  stated  to  a  nicety  (ets 
oLKpL^etrjv,  to  use  the  expression  of  Hippocrates), 
and  the  quantity  proper  to  be  taken  depends  on 
several  qualifying  circumstances. 

After  bronchitis  and  pneumonia,  the  cause  of 
mortality  shewing  the  next  highest  proportional 
number  is  phthisis  or  consumption  of  the  lungs, 
whose  proportional  number  is  73,128  for  the  year 
1900.  It  may  be  contended  that  to  this  ought 
to  be  added  the  proportional  numbers  of  other 
forms  of  tubercular  disease,  so  that  we  may  realise 
the  full  importance  of  this  cause  of  mortality.  If 
this  were  done,  and  if  the  proportional  number  of 
tabes  mesenterica,  or  consumption  of  the  bowels 
(10,166),  and  of  tubercular  meningitis,  or  consump- 
tion of  the  brain,  as  it  is  often  popularly  called 
(10,879),  and  also  the  proportional  number  of 
what  the  Registrar- General  calls  "  other  forms  of 
tuberculosis"  (10,112),  were  added,  the  proportional 
number  of  tuberculosis  in  general  would  stand  at 
the  very  high  figure  of  104,285,  or  over  one-tenth 
of  the  total  mortality.  Of  course,  if  this  were  done, 
it  would  be  necessary  to  take  the  proportional 
number,  say,  of  the  whole  of  the  respiratory 
diseases     in     order     to     have     a     fair     comparison 


58 

of  the  mortality  due  respectively  to  tubercular 
and  to  simple  respiratory  diseases.  In  this  case, 
tuberculosis,  accounting  for  104,285  deaths  out  of 
a  million  from  all  causes,  would  be  compared  with 
182,355  caused  by  respiratory  diseases.  Diseases  of 
the  circulation  again  account  for  93,857  deaths  out 
of  every  million  that  happen.  To  this,  however,  I 
think  the  proportional  number  of  apoplexy  ought  to 
be  added,  because,  although  apoplexy  shews  itself 
chiefly  in  nervous  phenomena  such  as  paralysis  and 
coma,  still  it  is  essentially  dependent  on  degenera- 
tion and  rupture  of  vessels,  changes  in  whose 
condition  really  belong  to  diseases  of  the  circulatory 
apparatus.  This  number,  32,509,  if  added  to, the 
proportional  number  of  diseases  of  the  circulation, 
would  raise  the  latter  to  126,366,  a  very  high  figure 
indeed. 

Of  "  old  age "  as  a  cause  of  mortality,  the 
proportional  number  (next  highest  on  the  list)  is 
54,056  for  the  year  1900.  In  a  community  quite 
healthy,  or  even  approximating  to  that  condition, 
this  cause  of  mortality  ought  to  be  very  much 
higher.  It  is,  in  fact,  a  task  for  medicine  to  explain 
why  only  about  5^  per  cent,  of  the  total  mortality 
is  due  to  old  age.  We  ought  to  have  a  very  much 
higher  proportion.  As  to  the  influences  of  food  and 
feeding  on  the  attainment  of  old  age,  a  considerable 
amount  of  evidence  ought  to  be  available.  If,  at 
least,  we  can  connect  the  causation  of  some  of  the 
diseases  already  named,  and  which  often  prevent  the 
onset    of    "  old   age "  —  if    we    can   connect    those 


59 

diseases  or  any  of  them  with  improper  feeding,  we 
shall  incidentally  shew  the  connection  between 
proper  feeding  and  the  attainment  of  old  age. 
Respiratory  diseases,  it  appears  to  me,  diseases  of 
the  circulation,  and  tubercular  diseases,  all  seem 
directly  connected  with  mal-nutrition ;  and  I  hope  to 
adduce  evidence  in  support  of  this  view  in  the 
sequel. 

Next  after  old  age,  as  a  cause  of  mortaUty, 
comes  cancer,  whose  proportional  number  is  45,457 
for  1900  in  England  and  Wales.  I  dwell  at  some 
length  on  cancer  in  a  later  part  of  this  essay,  and 
therefore  need  not  do  more  here  than  say  what  I 
have  no  doubt  at  all  is  the  simple  truth,  viz.,  that 
from  first  to  last,  from  its  commencement  in 
indigestion,  loss  of  teeth,  anaemia  (triphthsemia,  or 
catatribsemia  rather),  pallour,  fatigue,  rheumatism, 
and  constipation,  to  its  later  manifestations  in 
epithelial  and  connective  tissue  overgrowth  with  its 
limited  molecular  caries,  or  more  general  necrosis,  or 
molecular  or  general  death  of  larger  parts  of  the  body 
and  their  elimination  or  exfoliation  with  offensive 
putrefying  odour  into  the  outer  world,  and  finally 
to  its  culmination  in  hsemorrhage  or  the  effusion  of 
inamense  quantities  of  usually  bloody  serum  into 
the  body  with  or  without  the  development  of  micro- 
organisms ;  from  first  to  last  cancer  is  a  disease  of 
mal-assimilation  of  food,  and  that  mal-assimilation 
is  caused  not  by  too  little  but  by  too  much  food, 
and  particularly  by  too  frequent  feeding.  When  this 
process  has  gone  on  for  many  years,  it  is,  as  a  rule, 


60 

impossible  that  cure  can  be  effected.     We  might  as 
well  ask  that  the  effects  of  a  devastation  should  be 
undone,    that   the    drowned    in    a    flood    should    be 
brought  to  life  again,  or  the  victims  of  La  Souffrifere 
or  Mont  Pelee  should  be  requickened.     Prevention 
might  have  been  easy  and  simple  had  steps  been 
taken  at  the  proper  time,  but  when  that  time  has 
been   allowed   to   go  by,   cure    is  impossible.     The 
medical  profession  cannot,  nor  can  any  body  of  men, 
clerical  or  lay,  accept  the  role  which  the  public  are 
too  apt  by  implication  or  avowal  to  present  to  them, 
viz.,  to  relieve  humanity  from  the  effects  of  their 
action  without  altering   their  habits.     Not  in  this 
way  is  power  over  nature  attained  ;  and  if  we  refuse 
to  put  some  necessary  restraint  on  ourselves  when  we 
have  still  the  power  and  opportunity  to  do  so,  we  shall 
certainly  find  it  vain  to  stretch  out  hands  too  late 
in  mute  appeal  to  surgery  or  medicine,  demanding 
that  they  should  cure  the  incurable  or  re- vivify  the 
dead.     This  explanation   may  not  perhaps  account 
for  all  the  cases  of  this  sort  that  are  met  with  in  the 
practice  of  medicine  ;  a  certain  small  proportion  will 
still  perhaps  be  inexplicable,  are  there  always  must 
be  anomalies  and  exceptions  to  every  rule  ;  but  if 
nine-tenths  of  the  cases,  or  nineteen-twentieths  of 
them,  are  so  accounted  for,  and  if  an  alteration  in 
our  habits  should  enable  us  to  prevent  so  large  a 
proportion  of  incurable  diseases,  we  might  reason- 
ably say  that  we  had  solved  the  dreadful  problem  of 
the  prevention  of  cancer.     That  this  is  within  our 
reach  I  have  no  doubt.     Cure  may  be  practically 


61 

impossible  (for  what  is  the  good  of  talking  of  cure 
when  the  most  we  can  do  is  to  save  say  one,  two  or 
three  per  cent,  of  the  cases?),  but  prevention  is  easy 
and  simple. 

Diarrhoea  and  dysentery,  whose  proportional 
number  for  1900  in  England  and  Wales  was  38,984, 
are  next  on  the  list  of  the  causes  of  mortality.  These 
are  diseases  markedly  dependent  on  improper  feeding. 
I  should  take  it  that  this  is  a  case  in  which  there  will 
be  little  or  no  difference  of  opinion  among  experts, 
not,  of  course,  to  the  view  that  improper  feeding  is 
the  only  cause  of  the  incidence  of  and  the  mortality 
from  those  affections,  but  certainly  that  it  is  much 
the  most  important  one.  Diarrhoea  is  a  large  cause 
of  mortality  among  infants.  In  1900,  of  the 
22,916  deaths  attributed  in  England  and  Wales  to 
diarrhoea  and  dysentery,  20,542,  or  about  ten- 
elevenths,  or,  say  90  per  cent.,  occurred  among 
children  under  five  years  of  age ;  and  it  is  the 
opinion  of  medical  officers  of  health  that  a  very 
large  proportion  of  mfant  mortality  is  due  to 
improper  feeding.  I  think  I  need  hardly  quote 
authorities  to  prove  a  statement  regarding  the 
truth  of  a  view  so  generally  held  as  this. 

Convulsions,  whose  proportional  number  for 
1900  is  31,475,  comes  next  on  the  list.  This 
affection  occurs  almost  entirely  among  infants.  Of 
18,502  deaths  attributed  to  this  cause  in  the  year 
mentioned,  18,344,  practically  all  of  them,  occurred 
among  children  under  jSve  years  of  age.  By 
common  consent  these  diseases  are  often  attributed 


62 

to  errors  of  diet.  Convulsions  often  appear  in  the 
course  of  an  attack  of  diarrhcea  or  of  some  other 
acute  illness,  and  many  of  them  can  be  connected 
with  errors  of  diet. 

We  next  come  on  influenza  with  a  proportional 
number  of  27,636  deaths  to  a  million  from  all 
causes,  measles  with  21,622,  whooping  cough  19,507, 
and  diphtheria  15,897.  These  all  belong  to  the 
group  of  zymotic  diseases,  whose  proportional  number 
(exclusive  of  cholera,  diarrhoea,  &c.)  amounted  to 
101,600  in  1900,  one  of  the  very  largest  groups  of 
causes  of  mortality.  Further  on  in  this  essay  I 
adduce  (Chap.  IV. )  what  seems  reasonable  evidence  to 
shew  that  these  diseases  are  probably  also  somewhat 
dependent  on  wrong  feeding,  although  it  is  customary 
to  attribute  them  almost  wholly  to  vitiated  air.  I 
do  not  deny,  however,  that  the  latter  is  also  an 
important  cause  of  the  fevers.  I  also  shew  that  for 
ten  years  past  the  fevers  or  zymotic  diseases  have 
not  diminished  in  England  and  Wales,  although  we 
certainly  have  not  intermitted  our  efibrts  towards 
the  obtaining  of  better  sanitation  in  the  restricted 
sense  of  that  term.  For  the  three  years  1890,  1891 
and  1892,  the  proportional  numbers  of  the  zymotic 
diseases  in  England  and  Wales  were  130,200, 
133,960,  and  146,579  respectively.  In  1897  the 
proportional  number  was  148,908.  In  1898  it  was 
158,343,  and  in  1899  it  was  154,450.  The  pro- 
portional numbers  are  higher  at  the  end  of  the  ten 
years  than  they  were  in  the  beginning  of  the  period. 
It  appears  either  that  we  are  in  course  of  exhausting 


63 

the  benefit  which  we  may  expect  to  receive  from 
sanitation  in  the  restricted  form  in  which  alone  it  is 
customary,  unfortunately,  to  use  the  term,  or  that 
we  have  overlooked  a  main  or  important  part  of  the 
cause  of  the  z3niiotic  diseases.  I  beheve  myself 
that  weight  must  be  attached  to  both  of  these 
suggestions.  It  is  certainly  strange  that  if  fevers 
are  dependent  on  bad  air  and  overcrowding,  &c., 
they  should  not  only  not  continue  to  fall  in 
frequency  in  response  to  our  continuous  efforts  to 
improve  conditions  in  these  respects,  but  that  their 
proportional  number  should  actually  increase.  I 
have  little  doubt  that  an  important  factor  in 
their  causation  has  been  overlooked,  and  I  have 
equally  little  doubt  that  that  factor  is  the  food 
habits  of  the  people,  the  too  frequent  and  too 
abundant  meals  which  they  habitually  ingest  both 
into  themselves  and  their  children.  When  Sydenham 
suggested,  at  the  time  of  the  English  revolution, 
that  fevers  came  e  mscerihus  terrarum^  out  of  the 
bowels  of  the  earth,  it  might  have  been  suggested 
to  him  that  perhaps  a  main  part  of  the  cause  arose 
e  visceribus  hominum,  out  of  the  over-loaded  diges- 
tion of  men.  The  idea  is  not  so  unlikely  as  might 
have  been  thought.  It  is  not  even  new.  The  sanitary 
genius  of  Moses  was  not  bound  down  by  the  notion 
that  plague  depended  upon  bad  aii%  for,  as  we  have 
seen,  he  attributed  the  attack  that  his  people  sustained 
from  that  zymotic  disease,  to  the  quails  which  they 
stood  up  and  gathered  during  a  whole  day  and  a 
night  and  all  the  next   day,  and  which  no  doubt 


64 

they  ate  in  great  excess.  But  after  burying  his 
dead  at  Kibroth-hattaavah,  and  apparently  beUeving 
that  the  ground  and  the  air  were  infected  with  the 
pestilence,  he  moved  his  camp  also  to  Hazeroth,  so 
taking  steps  to  get  rid  of  the  double  cause  of 
improper  feeding  and  infection  of  land  and  air.  If 
modern  sanitarians  would  follow  this  sagacious  and 
broad-minded  example,  they  would  no  doubt  find 
that  instead  of  the  zymotic  diseases  gaining  on 
them  in  spite  of  their  efforts,  they  would  have  the 
satisfaction  of  seeing  that  their  sanitary  efforts  were 
prevailing  against  the  zymotic  diseases.  And,  I 
think,  if  they  were  dealing  with  the  whole  of  their 
causation,  and  not  with  a  part  of  it  only,  they  would 
find  that  they  could  so  advise  the  people  as  that  they 
might  get  rid  not  of  the  half  only  of  the  number 
and  mcidence  of  these  diseases,  but  of  a  proportion 
somewhere  between  three-quarters  and  nine-tenths. 
Under  specious  phrases  like  the  progress  of  science 
and  the  like,  we  seem  far  too  ready  complacently  to 
assume  that  we  know  everything  while  the  people 
who  went  before  us  knew  nothing  ;  but  the  assump- 
tion is  not  always  true  in  either  direction. 

To  diseases  of  the  digestive  system,  more  par- 
ticularly diseases  of  the  mouth,  stomach,  intestines, 
liver,  spleen,  lymphatics,  &c.,  the  proportional 
number  of  some  61,801  deaths  were  attributed  in 
1900  in  England  and  Wales ;  and  if  to  these  the 
proportional  number  of  deaths  due  to  diseases  of  the 
kidneys  and  to  Bright's  disease — some  21,200 — be 
added,  we  reach  the  large  proportional   number  of 


65 

83,000  as  that  of  the  diseases  of  the  digestive 
system.  If  we  take  a  wider  view  of  things,  no 
doubt — and  this  is  in  one  word  the  thesis  of  the 
present  essay — diseases  directly  or  indirectly 
attributable  to  the  digestive  system  are  very  much 
more  numerous  than  this ;  but  this  is  the 
proportional  number  given  by  the  Registrar  general 
as  applying  to  England  and  Wales  for  the  year 
1900 ;  and  it  forms  about  a  twelfth  of  the  total 
mortality. 

The  only  remaining  important  group  of  diseases 
to  which  mortality  is  attributable  is  diseases  of  the 
nervous  system.  It  is  a  little  difficult  to  gauge 
its  value  or  to  state  its  proportional  number  for 
various  reasons.  Its  proportional  number  includes 
apoplexy,  for  instance,  in  the  Registrar-General's 
return,  but  I  have  already  said  that  I  think 
apoplexy  (accounting  for  a  proportional  number 
of  32,509  deaths  in  1900)  would  be  better  classified 
under  diseases  of  the  vessels,  since  it  is  rupture  of 
the  arteries  which  is  the  main  cause  of  apoplexy; 
and  the  brain  softening  and  degeneration  following 
are  consequences  of  this  and  of  the  softening 
changes  which  occur  in  the  blood-clot  effused  on  to 
the  surface  or  into  the  substance  of  the  brain  or 
other  parts  of  the  nervous  system.  The  nervous 
system,  in  fact,  being  the  organ  of  the  controlling 
power  in  the  body,  has  a  very  high  measure  of 
vitality,  as  if  it  were  the  intention  of  nature  to 
preserve  it  to  the  last  extremity.  In  death  from 
direct  starvation,  for  example,  while  other  parts  of 

E 


66 

the  economy  lose  great  parts  of  their  weight,  the 
nervous  system  scarcely  wastes  at  all.  The 
significance  of  this,  though  not  the  existence  of  it, 
has  been  in  a  manner  discovered  by  Dr.  Dewey,  of 
Meadville,  Pennsylvania,  who  quotes  from  Dr. 
Burney  Yeo  statements,  which  he  has  entitled 
"Nature's  Bill  of  Fare  for  the  Sick."  Besides 
quoting  it  in  the  text  of  his  book,  "  The  True 
Science  of  Living,"  Dr.  Dewey  places  it  in  capital 
letters  in  the  frontispiece  of  his  book.  He  shews 
that  in  illness,  when  we  are  using  up  the  materials 
accumulated  in  our  bodies  (and  the  same  is  true 
in  death  due  to  direct  starvation,  as  when  sailors, 
e.g.,  are  confined  in  a  boat  without  food)  we  may 
use  as  much  as  91  per  cent,  of  our  fat  (practically 
all  of  it),  that  of  muscle  we  may  use  as  much  as 
30  per  cent.,  that  the  spleen,  a  blood-making  gland, 
may  waste  to  the  extent  of  63  per  cent.,  the  liver 
as  much  as  56  per  cent.,  and  the  blood  itself  be 
absorbed  to  the  extent  of  17  per  cent,  of  its  total 
amount.  That  in  these  circumstances  the  brain 
and  nerve  centres  scarcely  waste  at  all  is  surely  a 
most  significant  fact,  and  is  closely  related  to 
another  of  scarcely  less  importance,  viz.,  that  the 
nervous  system  is  not  particularly  liable  to  suffer 
from  direct  disease  of  its  proper  substance.  It  is 
its  vessels  which  become  diseased,  and,  by  their 
rupture,  indirectly  destroy  its  controlling  power ; 
or  it  is  its  fibrous  coverings  which  become 
infiltrated  with  gouty  or  rheumatic  exadation,  and 
so  lead  to  defect  of  its  functions,  to  excess  of  its 


67 

functions,  or  to  such  irregularity  of  its  ftinctional 
power  as  compels  us  often  to  send  persons  to 
asylums  where  they  can  receive  more  care  than 
it  is  possible  for  them  to  obtain  at  home. 
Considerations  of  the  same  kind  incline  me  to  think 
that  even  "  hemiplegia  and  brain  paralysis,"  to 
which  the  Registrar- General  attributes  a  pro- 
portional number  of  mortality  in  1900  of  10,384, 
ought  to  be  also  relegated  to  the  diseases  of  the 
vessels  of  the  brain,  that  is,  to  diseases  of  the 
circulation.  However,  I  have  still  retained  it 
among  diseases  of  the  nervous  system,  and  I  find 
that  in  this  case,  but  deducting  the  proportional 
number  of  apoplexy  (32,509),  of  convulsions,  which 
is  mostly  a  disease  of  infancy  due  to  improper 
feeding  (31,475),  and  of  laryngismus  stridulus,  also 
a  disease  of  infancy  and  early  childhood,  and 
mostly,  I  think,  catarrhal,  and  due  also  to  wrong 
feeding  (742),  there  remains  47,917  as  the 
proportional  number  of  the  mortality  attributed  by 
the  Registrar- General  to  diseases  of  the  nervous 
system  for  England  and  Wales  for  the  year  1900. 
The  causes  enumerated,  then,  bronchitis,  pneumonia 
and  respiratory  diseases  in  general,  consumption  of 
the  lungs  and  other  forms  of  tuberculosis,  diseases 
of  the  circulation,  cancer,  convulsions,  the  zymotic 
diseases,  diseases  of  the  digestive  system,  including 
diseases  of  the  kidneys  and  Bright's  disease,  and 
diseases  of  the  brain  and  nervous  system,  account 
for  the  bulk  of  the  causes  of  mortality  among  the 
population  of   England  at  all  ages.     If  it  can  be 

E2 


68 

shewn,  or  if  good  reason  can  be  advanced  for  the 
opinion,  that  these  causes  of  mortality  and  disease 
are  more  aggravated  by  improper  food  habits  than 
by  any  other  means,  and  if,  therefore,  more 
improvement  can  be  effected  in  the  incidence  of 
these  diseases  on  humanity  by  alteration  of  the 
food  habits  of  the  people  than  in  any  other  way,  or 
even  if  it  can  be  shewn  to  be  probable  that  such 
alterations  in  food  habits  would  be  likely  to 
diminish  the  virulence  and  power  of  these  causes  of 
disease  and  mortality,  the  task  which  I  have  set 
before  myself  in  this  essay  will  have  been 
accomplished.  For  then  it  will  have  been 
incidentally  shewn  that  a  great  part  of  the  causes 
of  the  evils  from  which  we  suffer  is  diminishable  by 
our  own  exertions,  and  can  be  reduced  by  better 
management  of  ourselves. 

We  have  not  yet,  however,  received  the  answer 
to  our  question — what  are  the  chief  causes  of 
mortality  among  the  active  portion  of  the 
population  living  between  the  ages  of  5  and  65 
years  ?  I  am  sorry  to  have  to  beg  the  reader's 
attention  still  to  what  he  may  consider  details  of 
dry  arithmetic,  but  if  I  do  so  for  yet  a  little  while, 
it  is  because  I  am  afraid  I  cannot  put  the  problem 
before  him  in  any  easier  or  simpler  way.  Happily 
the  study  already  given  to  the  causes  of  mortality 
in  general  among  the  English  population  has 
rendered  examination  of  the  causes  of  mortality 
between  ages  5  and  65  years  by  so  much  easier,  and 
our  next  chapter,  therefore,  will  be  a  short  one. 


69 


CHAPTEE  III. 


The  Principal  Causes  of  Mortality  in  England 
and  Wales  between  the  Ages  of  Five  and 
Sixty-five  Years. 


FN  the  year  1900  there  were  in  England  and 
Wales,  as  has  already  been  said,  587,830  deaths, 
and  of  these  209,960,  or  over  35  per  cent,  occurred 
among  children  under  five  years  of  age.  This  is  a 
large  proportion  of  the  mortality,  but  it  is  not  at 
all  an  unusual  one.  If  anything,  indeed,  it  is  lower 
than  usual.  In  1893,  for  instance,  there  occurred 
in  England  and  Wales  569,958  deaths,  and  of  these 
216,833,  or  about  40  per  cent.,  took  place  among 
children  under  five  years  of  age.  Year  after  year 
it  is  the  same,  from  one  third  to  two  fifths  of  all 
the  deaths  that  occur  in  the  country  happening 
under  five  years  of  age.  In  our  towns  it  is  the 
same.  In  1901  4,701  deaths  were  registered  in 
Bradford,  and  of  these  1,512,  or  32  per  cent., 
occurred  among  children  under  five  years  of  age. 
There  being  thus  about  32  to  40  per  cent,  of  the 
total  mortality  under  five  years  of  age,  that 
proportion  of  the  mortality  may  be  left  out  of 
account.     As    to    the    causes    of    that    mortality, 


70 

however,  my  general  argument  is  not  weakened  but 
strengthened,  it  being  the  opinion  of  medical 
officers  of  health  that  a  great  part  of  its  cause  is 
improper  feeding.  If  this  is  so  under  five  years  of 
age,  and  as  no  noticeable  break  or  gap  occurs 
between  the  modes  of  management  of  children 
under  five  years  of  age  and  those  over  that  age, 
or  at  subsequent  ages,  it  is  probable  that  mortality 
is  induced  by  the  action  of  similar  causes  at  all 
ages,  and  therefore  that  the  view  which  attributes 
a  large  proportion  of  the  mortality  at  more 
advanced  ages  to  wrong  feeding  is  prima  facie  at 
least  not  improbable.  Let  us  now  look  at  the 
mortality  at  the  other  extreme  of  life.  I  have 
taken  65  years  and  not  70  as  the  point  from  which 
to  examine  the  mortality  because  it  is  an  easier 
problem  for  medicine  to  prolong  life  to  65  than  70, 
although  I  do  not  for  a  moment  suggest  that  we 
ought  to  let  65  years  of  age  form  the  limit  of  our 
ambition.  If  medicine  succeeded  in  raising  the 
age  at  death  to  65  years,  her  ambitions  would  very 
soon  rise  to  70  and  beyond.  Meantime  it  seems 
hopeless  to  talk  about  such  a  thing,  so  very  little 
has  yet  been  done  towards  increasing  life  at  the 
active  and  useful  ages.  In  1900,  then,  there  died 
in  England  and  Wales  142,496  persons  over  65 
years  of  age  out  of  the  587,830  deaths  occurring 
that  year.  That  was  about  24  per  cent.,  and  this 
forms  year  after  year  about  the  proportion  of  the 
population  who  reach  not  70  years  of  age,  but  65. 
In  the  towns  again  it  is  the  same.     In  1901,  out   of 


71 

the  4,701  deaths  registered  in  Bradford,  1,038,  or 
22  per  cent.,  attained  the  age  of  65  years  or 
upwards.  On  the  assumption  that  life  is  worth 
hving,  this  does  not  seem  to  me  a  satisfactory- 
result.  Further,  if  life  could  be  prolonged  in  health 
and  activity  and  interest,  the  objection  frequently 
felt  by  persons  who  hve  long,  to  the  solitude 
experienced  by  them  in  the  loss  of  their  friends 
would  not  count  for  so  much,  since  the  same  causes 
which  might  lead  to  the  prolongation  of  their  life 
would  lead  to  the  longevity  of  their  friends. 
Deducting,  then,  the  209,960  deaths  under  five 
years  along  with  the  142,496  which  occurred  over 
65,  there  remain  235,374  deaths  to  be  accounted  for 
between  five  and  65  years  of  age — which  we  may 
term  the  deaths  at  the  active  stages  of  life.  From 
what  causes  did  these  deaths  occur  ?  In  the  order 
of  their  frequency,  and  therefore  of  their 
importance,  we  gather  from  the  Registrar-General 
that  they  are  the  following  : — 

1.  The  most  numerous  group  is  that 
attributed  by  the  Registrar- General  to  con- 
stitutional diseases  which  includes  consumption 
of  the  lungs  and  other  forms  of  tuberculosis,  cancer, 
and  rheumatism.  This  group  accounts  for  71,004 
deaths  out  of  the  235,374  to  be  accounted  for. 
Practically  it  is  tuberculosis  and  cancer  which  are 
to  be  considered,  for  the  former  accounted  for 
48,931  deaths  between  five  and  65  years  of  age, 
and  the  latter  for  17,026.  Rheumatism  and  gout 
were    not     directly     large     causes     of     mortality, 


72 

although  it  would  be  very  unwise  to  infer  from  this 
that  these  are  unimportant  diseases.  Both 
rheumatism  and  gout  are  very  important  and  very 
dangerous  conditions  of  body  indeed,  but  they  are 
so  far  more  in  relation  to  what  they  mean  and  to 
the  evils  which  they  portend  as  about  to  ensue  in 
the  body,  than  in  themselves.  This  quality  is 
shewed  by  other  diseases  besides  rheumatism  and 
gout,  and  is,  indeed,  a  characteristic  of  many  of 
the  minor  ailments,  especially,  for  instance, 
indigestion,  in  which  nearly  all,  or  at  least  a  very 
large  proportion  of  diseases  have  their  origin. 

2.  The  next  most  important  cause  of  death 
between  five  and  65  years  of  age  is  diseases  of  the 
circulation,  I  ought  to  say  that  I  have  added  the 
deaths  caused  by  apoplexy  to  those  attributed  by 
the  Registrar- General  to  diseases  of  the  circulation 
for  reasons  mentioned  in  the  previous  chapter,  and 
have  therefore  removed  the  deaths  due  to  apoplexy 
from  those  attributed  to  diseases  of  the  nervous 
system.  Diseases  of  the  circulation,  then,  and 
apoplexy  account  for  40,332  deaths  out  of  the 
285,374  in  question.  Apoplexy  alone  accounted  for 
19,110  of  these  deaths,  so  important  a  cause  of 
mortality  is  it. 

3.  The  next  largest  cause  of  mortality  at 
these  active  ages  of  life  is  diseases  of  the 
respiration,  which  account  for  36,321  deaths.  Of 
these  bronchitis  and  pneumonia  together  accounted 
for  31,383  deaths,  so  that  the  deaths  due  to  other 
diseases  of  the  respiratory  system  are  comparatively 


73 

unimportant.  Diseases  of  the  respiration  are, 
among  persons  living  at  the  active  ages  of  Hfe,  as 
well  as  among  the  population  in  general  at  all 
ages,  a  very  important  cause  of  mortality. 

4.  The  next  most  important  cause  of  death, 
according  to  the  Registrar- General,  is  "  old  age," 
which  accounts  for  31,146  deaths  under  65  years  of 
age.  I  have  already  said  that  all  would  like  to  see 
this  cause  of  death  greatly  increased,  and  to  see 
life  lived  as  it  ought  to  be,  till  it  determined  in 
decay  of  nature  rather  than  in  succumbing  to 
disease.  "  Old  age,"  in  fact,  under  65  years  of  age, 
and  particularly  under  60  or  less,  would  appear 
to  be  a  misnomer.  If  persons  succumb  to  ' '  old 
age"  at  such  ages,  it  is  likely,  on  the  face  of  it,  that 
they  have  in  some  way  mismanaged  themselves,  so 
as  to  make  themselves  old  before  their  time,  and  it 
will  be  well  before  making  any  other  inquiry  to  try 
to  see  whether  a  main  cause  of  this  is  not  over- 
filling of  the  body  with  food  and  drink,  so  clogging 
its  actions  and  bringing  its  powers  to  a  stand- 
still. 

5.  The  cause  next  in  importance  of  mortality 
between  five  and  65  years  of  age  in  England  in 
1900  was  the  zymotic  diseases.  We  saw  how  very 
important  a  cause  of  death  this  set  of  diseases  is 
among  the  whole  population  at  all  ages  ;  and  now 
we  find  that  between  five  and  65  years  of  age  it 
accounts  for  29,766  deaths  out  of  the  235,374 
to  be  accounted  for.  This  would  give  a  pro- 
portional number  of  126,000  out  of  a  million  deaths 


74 

from  all  causes,   or  about  an   eighth  of   the   total 
mortality. 

6.  The  next  most  important  cause  of  death 
between  five  and  65  years  of  age  is  the  diseases  of 
the  digestive  system,  which  in  1900  accounted  for 
14,638  deaths  out  of  the  235,374  which  occurred  in 
England  and  Wales  in  that  year.  This  is  still  a 
large  proportion,  although  if  the  arguments  on 
which  I  have  relied  are  sound,  this  number,  large 
as  it  is,  by  no  means  represents  the  number  of 
deaths  due  to  disorders  of  the  digestion.  As  it  is, 
however,  it  represents  a  proportional  number  of 
62,000  out  of  a  million  deaths  from  all  causes. 

7.  Lastly,  deducting  apoplexy  (a  very  im- 
portant cause  of  death,  as  has  been  shewn),  diseases 
of  the  nervous  system  accounted  for  8503  deaths 
out  of  the  235,374  between  five  and  65  years  in 
England  in  1900. 

From  these  seven  causes  of  death,  we  find  that 
231,710  deaths  are  accounted  for,  out  of  the  235,374 
in  question  in  England  and  Wales  in  1900,  so  that 
the  remainder,  due  to  parasitic  diseases,  dietetic 
diseases,  &c.,  is  very  trifling.  The  class  of  dietetic 
diseases,  I  may  say,  however,  includes  the  deaths 
from  chronic  alcoholism  and  delirium  tremens,  and  is 
put  at  the  too  low  figure  of  3638  at  all  ages  for 
Ensfland  in  1900.  As  chronic  alcoholism  causes 
disease  in  various  organs,  as  the  liver,  kidneys,  lungs, 
heart,  brain,  and,  in  fact,  in  almost  all  organs,  deaths 
that  ought  to  be  set  down  to  alcoholism  are  far  more 
frequently  referred  to  diseases  of  those  organs,  so 


75 

that  the  Registrar- General's  returns  are  no  guide, 
and  do  not  even  offer  an  approximation  to  the 
number  or  proportion  of  deaths  due  to  this  cause. 
It  is  quite  natural,  of  course,  that  relatives  should 
not  like  to  have  the  deaths  of  their  friends  put 
down  to  alcoholism,  but  their  unwillingness  to  let 
this  be  done  must  not  be  allowed  to  blind  us  to  the 
real  facts  of  the  case.  Chronic  alcoholism  no  doubt 
accounts  for  a  frightful  amount  of  mortality  in 
England  if  the  truth  could  be  known ;  and  no 
doubt  also  it  is  a  most  shocking  cause  of  death, 
since  no  other  cause  equally  lowers  the  power  of  the 
intellect  in  the  government  of  men  and  women, 
sears  their  conscience  and  blunts  their  sense  of 
refinement,  or  shuts  their  heart  to  the  claims  of 
those  dependent  on  them.  Bad  as  alcoholism  is  in 
these  respects,  however,  and  terrible  in  so  many 
ways,  it  is  not  by  a  long  way  so  potent  a  cause  of 
mortality  or  of  disease  as  improper  feeding  ;  and  I 
cannot  help  thinking  that  if  the  teetotallers,  instead 
of  confining  their  attention  to  the  evil  effects  of 
alcoholic  drink  alone,  had  widened  the  scope  of 
their  inquiries  and  extended  them  to  the  effects  of 
intemperance  in  the  use  of  food  also,  they  would 
have  effected  much  more  good  than  they  have 
yet  succeeded  in  doing.  There  are  passages  in  the 
writings  of  well-known  medical  writers  on  the  evil 
effects  of  alcohol,  referring  a  long  succession  of 
bodily  evils  to  the  effects  of  alcoholism,  every  one 
of  which  I  have  seen,  and  that  not  once,  but  over 
and   over   again,   occurring   in   the   life   history   of 


76 

teetotallers  who  were  perfectly  sincere  in  their  state- 
ment that  they  abstained  entirely  from  alcoholic 
drink.  I  am  very  sorry  to  say  this,  because 
I  recognise  to  the  full  the  good  intentions  of 
teetotallers  and  their  sincere  desire  to  benefit  their 
kind  in  the  best  and  highest  ways,  by  inculcating 
on  them  the  need  for  self  control,  and  by  shewing 
them  how  to  achieve  it.  And  I  have  endorsed  the 
practice  of  the  teetotallers  by  being  one  myself  for 
years,  so  that  I  know  of  what  I  speak.  No  doubt 
they  have  shewn  that  alcohol  is  not  necessary  to 
persons  in  health,  and  that  long  and  active  and 
useful  life  is  attainable  without  its  use,  while  I 
think  they  have  shewn  also  that  childhood  and 
youth  are  better  without  it.  But  nothing  is  gained 
by  exaggeration,  or  by  attributing  to  one  cause 
what  is  often  due  to  another,  as,  for  instance,  in 
the  following  passage,  in  which  a  distinguished 
physician  said  that  "it  is  the  prevalence  of  beer 
and  spirit  drinking,  and  consequent  liver-clogging, 
which  accounts  for  the  widespread  use  and  countless 
forms  of  patent  pills  such  as  Cockle's,  Morison's, 
Holloway's,  and  others.  These  are  taken  by 
millions  every  week,  and  people  find  that  if  they 
do  not  take  them  they  become  bilious  and  unwell." 
And  then  he  goes  on  to  suggest  that  the  chief 
reason  for  all  this  constipation  and  clogging,  so  very 
deleterious  to  the  system,  I  freely  admit,  is  caused 
by  "  gin-drinker's  liver."  But  while  this  is  some- 
times a  cause  of  the  constipation  which  drives 
people     foolishly    to     take     aperients,    by    which, 


77 

nevertheless,  they  cannot  cure  it,  surely  it  is  not 
the  only  cause  or  the  chief  cause.  It  is  impossible 
that  constipation,  so  prevalent  a  condition  in  young 
and  old  and  in  middle-aged,  and  in  all  sorts  and 
conditions  of  men  and  women,  can  be  due  to  alcohol 
as  its  commonest  cause'  It  is  not  compatible  with 
common  experience  to  say  so.  Thousands  of  the 
young  women,  for  example,  suffering  in  this  way 
never  take  alcohol  at  all ;  and  what  it  is  due  to  far 
more  than  to  anything  else  is  excess  not  in  alcohol 
but  in  food,  and  particularly  to  the  widespread 
habit  of  taking  too  many  meals.  The  modus 
operandi  also  of  this  habit  and  its  consequences  are 
quite  plain.  Too  much  chyle  gets  into  the  blood 
through  over-feeding.  The  excess  of  nutritive 
material  so  introduced  must  be  used  somehow,  and 
by  means  of  it  the  muscular  fibres  of  the  bowel, 
and  particularly  the  transverse  or  circular  fibres, 
become  overgrown  or  hypertrophied.  The  effect  of 
this  is  to  make  these  overgrown  fibres  contract  too 
tightly,  especially  as  the  stimulus  of  too  much 
nutritive  material  in  the  blood  is  still  kept  up  by 
over-feeding.  In  this  way  the  firm  contraction  of 
these  fibres  narrows  the  lumen  or  channel  of  the 
bowel,  and  prevents  its  contents  from  passing;  or 
otherwise,  we  may  say,  causes  constipation,  and 
when  some  sort  of  action  does  occur,  it  causes 
the  evacuation  of  those  small  knotty  motions  so 
common  in  this  condition.  Let  the  constipated 
young  person,  who  is  constantly  taking  sugar  and 
spice  and   chocolates  between  her  meals,  give  up 


78 

this  pernicious  habit ;  let  her  or  him  who  is  in  the 
habit  of  taking  four  daily  meals,  try  the  effect  of 
three  for  three  months,  and  the  probability  is  that 
he  will  be  somewhat  less  constipated.  If  this  does 
not  cure  him,  however,  let  him  take  two  daily  meals 
for  six  months,  and  he  will  probably  become  regular, 
especially  if  he  will  take  frumitty  and  cooked  fruit 
at  one  of  his  meals,  and  the  well  boiled  onion  or 
fresh  lettuce,  tomatoes,  &c.,  at  the  other.  But  if 
this  is  insufficient  to  put  him  right  (but  it  will  fail 
very  seldom  indeed)  he  will  almost  certainly  become 
so  on  one  daily  meal.  Alcohol  is  sometimes,  no 
doubt,  a  cause  of  constipation,  but  sometimes,  on 
the  other  hand,  a  little  beer  has  the  opposite  effect 
— not  that  I  recommend  its  use  for  that  purpose, 
because  I  think  the  purpose  can  be  better  effected 
in  the  way  suggested — but  far  the  commonest 
cause  of  constipation  is  not  alcohol  but  too  much 
food. 

The  same  statements  are  true,  the  necessary 
name-changes  being  made,  as  regards  skin  eruptions, 
which  another  medical  authority  attributes  to 
alcohol.  I  do  not  deny  that  alcohol  may  cause 
acne  and  eczsema,  for  instance,  that  is,  that  beer 
may  cause  and  that  it  often  does  cause  spots  and 
redness  of  the  face  and  nose ;  but  the  large  majority 
of  the  cases  I  have  seen,  occurring  as  they  do  in 
young  women,  who  are  greatly  distressed  by  them, 
or  in  middle-aged  women,  many  of  whom  do  not 
touch  beer  or  stout  at  all,  much  less  brandy  or  other 
spirits,  have  been  caused  not  by  alcohol  but  by  too 


79 

much  starch  and  sugar  in  the  diet,  and  these  skin 
affections  are  really  very  easily  treated  by  diminish- 
ing the  number  of  meals  taken  and  by  restricting 
the  use  of  these  articles  of  food.  I  have  seen  many 
teetotallers  die  early,  say  between  50  and  60  years 
of  age,  not  from  their  teetotalism  at  all,  certainly 
not,  but  from  wrong  dieting  of  themselves,  and 
particularly  from  taking  too  many  meals.  In  fact, 
my  experience  leads  me  to  say  that  teetotallers,  as 
a  rule,  err  in  this  way  more  than  moderate  drinkers, 
and  having  been  deeply  impressed  by  the  truly 
shocking  and  degrading  and  demoralising  effects  of 
alcoholic  drinking  (let  no  one  say  I  minimise  these  in 
the  least,  for  I  do  not)  have  exaggerated  its 
importance  and  extent,  and  so  have  attributed  to 
alcohol  many  effects  which  are  not  due  to  it  at  all 
but  to  wrong  feeding.  Will  any  doctor  seriously 
contend  that  say  one  glass  of  sherry  or  Madeira, 
taken  at  lunch,  and  one  small  whiskey  taken  at 
bed-time,  in  those  cases  where  it  suits — will  any 
doctor  seriously  contend  that  such  an  amount  of 
alcohol  taken  daily  will  shorten  the  life  of  the 
average  man  by  a  day  ?  I  do  not  believe  it  will, 
although  at  the  same  time  I  fully  admit  that  it  is 
not  necessary  to  life  or  health,  and  although  for  my 
own  part  I  quite  expect  to  hve  to  term  without  it. 
The  moral  and  social  grounds  for  abstinence  from 
alcohol  may  lead  persons  justly  to  become  teetotal 
themselves,  and  to  inculcate  total  abstinence  on 
other  people — this  style  of  argumentation  attracts 
me  very  much,  I  must  say — but  we  must  be  careful 


80 

not  to  transcend  the  bounds  of  truth  and  evidence 
even  for  a  good  cause,  and  we  must  also  sanely 
attempt  to  attribute  the  effects  of  excess  in  all 
directions  to  their  true  causes,  and  to  consider 
judicially  the  effects  of  too  much  food  as  well  as  of 
too  much  alcoholic  drink. 

Many  strange  things  happen  in  life  in  the 
observation  of  those  who  notice  what  they  see.  I 
knew,  for  example,  two  brothers,  one  of  whom 
lived  to  75  years  of  age,  the  other  attaining  the 
age  of  84.  The  former  was  a  sober,  righteous,  and 
godly  man,  the  centre  of  a  numerous  family  of 
nephews  and  nieces,  who  looked  to  him  as  to  a 
pattern  for  the  help  which  young  people  so  often 
need,  and  which  he  was  able  and  willing  to  give. 
He  died  of  a  dilated,  flabby,  weak  heart,  brought 
on,  I  believe,  partly  by  anxiety,  but  chiefly  because 
he  did  not  understand  digestion,  and  because  he 
ingested  into  his  blood,  habitually,  more  food  than 
he  required.  The  brother  was  such  a  rascal,  and 
had  so  little  command  over  himself  that  for  40 
years  he  never  went  to  bed  sober,  if  he  could  go 
drunk.  He  was  a  pleasant,  smiling,  agreeable  man 
to  strangers,  and  when  I  saw  him,  at  83  years  of 
age,  he  was  as  straight  as  a  dart,  and  as  nimble  as  a 
lamplighter.  Yet,  when  he  died  the  next  year,  so 
awful  had  been  his  family's  experience  of  his  vagaries, 
and  so  great  the  shame  he  had  put  them  to,  that 
his  own  daughter  went  down  on  her  knees  to  thank 
God  when  she  heard  of  his  death.  This  was  an 
exceptional  case,   no  doubt.     I  may  mention  that 


81 

the  longer  lived  brother,  although  he  drank  so 
hard,  was  a  very  spare  eater.  But  how  wrong  it 
would  be  of  me  if  I  were  to  advise  people,  because 
this  man  lived  in  spite  of  his  habits,  that  they 
should  go  and  do  likewise.  And  yet,  would  it  be 
any  more  untrue  to  nature,  or  any  less  dis- 
proportionate to  reality,  than  was,  for  example,  the 
language  of  a  compeer  of  my  own,  a  medical  man, 
who  practised  his  profession  for  over  30  years,  and 
who,  all  through  his  professional  life,  spoke  of 
alcohol  as  "  the  accursed  thing,"  advising  all  to 
abstain  totally  from  it  under  peril  of  eternal  loss  ? 
Or,  to  take  another  example.  Many  medical  men 
believe  that  much  damage  is  done,  and  many  fatal 
illnesses  are  brought  on  by  an  excess  of  starch  and 
sugar  in  the  diet.  But  do  we  value  their  judgment 
if  they  advise  total  abstinence  from  these  articles 
of  food  ?  Or  at  least  is  it  not  more  rational  of 
them  if  they  advise,  not  complete  abstinence,  but 
such  moderation  as  conduces  to  life,  and  health,  and 
usefulness  ?  The  effects  of  the  use  and  abuse  of 
alcohol  and  of  foods  (and,  I  may  add,  of  other 
things),  may  differ  greatly  in  detail,  but  our 
attitude  in  respect  of  them  must,  it  seems  to  me,  be 
in  principle  always  to  remember  that  moderation  is 
the  only  rule  which  never  fails  us. 


':>'^^^^?5<5^ 


82 


CHAPTER    IV. 


The  Causes  of  Disease  or  the   Causes   of  the 
Causes  of  Death.     Preliminary. 


rnOETALITY,  being  attributed  to  the  diseases 
already  named,  or  death  being  caused  by 
them,  an  inquiry  into  the  causes  of  these  diseases 
may  be  otherwise  considered  as  an  inquiry  into  the 
causes  of  the  causes  of  death.  Death  is,  of  course, 
the  natural  termination  of  life,  but  death  ought  to 
oc(iur  by  a  slow  wearing  out  of  the  natural  powers 
of  the  body.  It  very  rarely  does  so  ;  it  occurs  not 
from  old  age  but  from  disease,  for  the  most  part. 
Now  the  causes  of  disease  are  usually  considered 
under  three  divisions,  termed  respectively  the 
predisposing,  the  exciting,  and  the  proximate 
causes.  The  proximate  causes  of  disease  are  two, 
and  two  only,  viz.  :  shrinking  and  swelling,  or 
contraction  and  dilatation.  Organised  bodies,  like 
unorganised,  have  the  power  or  quality  of 
contracting  or  shrinking,  and  also  of  dilating,  or 
swelling,  or  expanding,  under  the  action  of  certain 
stimuli,  but  there  is  probably  this  difference 
between  them,  that  unorganised  bodies  may 
actually  shrink  into  smaller  compass,  so  as  to 
occupy  less  space  at  some  times  than  others,  under 


83 

the  contracting  action ;  while  organised  bodies,  if 
they  contract  or  shrink  in  one  direction,  usually 
expand  or  swell  in  another,  so  that  it  is  doubtful  if 
they  occupy  less  space  at  one  moment  than  at 
another.  (Of  course  organised  bodies  grow  and 
develope,  and  again  shrink  and  become  attenuated 
and  old,  so  that  at  different  periods  of  their  lives 
they  occupy  very  different  amounts  of  space  ;  but 
the  question  at  present  is  whether  they  occupy  more 
or  less  space  under  the  actions  of  contraction  and 
dilatation,  respectively,  at  very  short  intervals  of 
time,  as,  e.g. ,  iron  does  under  the  action  of  heat  and 
cold).  Usually,  when  an  organised  body,  as  the 
earth-worm,  for  example,  shrinks  in  one  direction, 
say  its  longitudinal  direction,  or  in  its  length,  it 
swells  or  expands  or  dilates  in  another  direction,  in 
its  width,  for  instance ;  so  that  the  space  it  occupies 
at  any  two  shortly  separated  intervals  of  time  is 
nearly  if  not  quite  the  same.  This  property  it 
probably  owes  to  the  water  which  always  forms  a 
large  proportion  of  the  structure  of  organised 
bodies,  water  being  for  practical  purposes  incom- 
pressible. A  fact  of  this  kind  seems  to  have 
greatly  impressed  early  inquirers  into  the 
constitution  of  nature,  one  of  them,  as  is  well 
known,  having  held  that  water  (or  moisture  as  we 
now  term  it),  is  the  ultimate  element  from  which 
all  things  are  formed  and  to  which  they  all  return. 
Certainly  without  moisture  life,  as  we  know  it, 
does  not  occur.  The  proximate  causes,  then,  being 
swelling    and    shrinking    (and   the   ancients   knew 

F2 


84 

them  under  a  great  many  different  names, 
especially  the  Greeks,  see  Chap.  VI. — the  Latins 
called  them  strictum  et  laxum),  it  appears  that 
these  so-called  causes  are  not  really  causes  so  much 
as  states.  These  two  causes  or  states  have  this 
peculiarity  when  manifested  in  organised  bodies, 
that,  whichever  of  them  appears  first  in  the  animal 
economy,  is  always  followed  by  its  opposite ; 
shrinking  by  swelling  and  swelling  by  shrinking, 
contraction  by  dilatation  and  dilatation  by  con- 
traction. If  a  muscular  fibre,  for  instance, 
contracts,  it  in  course  of  time  expands,  and,  after 
expanding,  it  again  contracts.  These  properties 
depend  on  the  constitution  of  the  organised  body, 
or  on  the  constitution  of  the  part  of  it  undei* 
consideration  ;  but  we  shall  not  be  betrayed  into 
the  fallacy  of  supposing  that  contraction  is  the 
cause  of  swelling,  although  it  always  precedes  it, 
nor  yet  that  swelling  in  turn  is  the  cause  of 
contraction  for  the  same  reason,  if  we  remember 
that  day  always  precedes  night  and  night  day, 
although  day  is  not  the  cause  of  night  nor  night 
the  cause  of  day.  These  offer  also  a  good  instance 
of  the  fact  that  invariable  succession  is  not  the 
same  thing  as  causation.  Nevertheless,  when  we 
find  one  thing  invariably  preceding  another,  we 
may  assume  that  there  is  some  causal  nexus, 
although  it  almost  always  takes  the  form  that  the 
two  phenomena  are  successive  effects  of  a  common 
cause,  although  they  are  not  cause  and  effect  of  one 
another.     Day   and   night,    for   example,   although 


85 

they  are  not  cause  and  effect  of  one  another,  are 
successive  effects  of  a  common  cause,  namely,  the 
rotation  of  the  earth  on  its  axis,  and  its  behaviour 
to  the  sun.  So  the  succession  of  swelling  on 
shrinking  and  vice  versa,  may  be  considered  best  as 
successive  effects  of  a  common  cause,  namely,  the 
constitution  of  the  tissues  of  organised  bodies. 

There  is  another  phase  of  the  relation  between 
swelling  and  shrinking  which  should  not  be 
overlooked,  for  failure  to  appreciate  its  significance 
has  led  to  the  greatest  confusion  in  medicine,  and 
is  probably  doing  so  to-day,  notwithstanding  all 
the  advance  which  is  alleged  to  have  been  made  in 
the  art.  It  is  this.  The  structure  of  many  parts 
of  organised  bodies,  of  the  arteries,  for  example, 
which  generally  convey  the  aerated  or  arterial 
blood  ;  of  the  intestines  and  of  other  parts  ;  is  in  two 
layers  of  contractile  structures,  one  of  which  goes 
along  the  length  of  the  structure,  and  the  other 
across  its  width.  These  are  called  respectively  the 
longitudinal  and  the  transverse  fibres  (or  circular, 
sometimes).  Now  it  is  evident  that  contraction  of 
the  longitudinal  fibres  must  cause  dilatation  of  the 
transverse  fibres,  and  that,  on  the  other  hand, 
contraction  of  the  transverse  fibres  must  cause 
dilatation  of  the  longitudinal.  In  other  words, 
contraction  in  the  length  of  a  vessel,  or  shortening 
it,  widens  its  width,  while  contraction  or  narrowing 
of  its  width  lengthens  its  length.  When  it  is 
added  that  these  two  sets  of  fibres  may  be  under 
the  control  of  two  different  sets  of  nerves,  and  that 


86 

not  infrequently  the  one  set  of  nerves  stimulates 
its  fibres  to  contraction  immediately  after  the  other 
set  has  ceased  to  stimulate  its  own,  it  is  evident 
how  complicated  may  be  the  actions  resulting  from 
the  successive  action  of  two  sets  of  structures 
acting  in  the  body.  Shortly,  the  complication  is 
apt  to  create  this  amount  of  confusion  in  the 
observations  of  an  inquirer  that  (1)  contraction 
appears  to  cause  dilatation  and  dilatation  appears 
to  cause  contraction,  and  (2)  that  stimulation  of  one 
set  of  nerves  appears  to  have  the  same  effect  as 
absence  of  stimulation  or  loss  of  control  by 
another.  That  is  to  say,  in  both  of  these 
directions,  actions  may  appear  to  produce  effects 
exactly  the  opposite  of  those  which  they  do 
exert.  It  is  a  little  away  from  our  subject  at  the 
present  moment,  but  perhaps  an  example  may 
illustrate  better  than  a  statement  what  is  wished 
to  be  conveyed ;  and  I  may  say,  therefore,  that 
contraction  of  fibres  may  either  contract  or  dilate 
the  pupil  of  the  eye,  and  that  parahsis  of  one  of 
its  nerves  of  supply  may  cause  the  same  dilatation 
as  is  produced  by  stimulation  of  another.  This 
complication  and  difficulty  also  arises  in  the  attempt 
to  understand  the  actions  of  many  other  parts  of 
the  body,  and  may  lead  us  astray  in  studying 
respiration,  cardiac  action,  intestinal  action,  sleep, 
thinking,  and  possibly,  indeed,  any  and  all 
functions.  Even  a  poor  imagination  may  perceive 
how  entirely  opposite  must  be  recommendations  as 
to    treatment   according    to    the    mode    in    which 


87 

various  changes  in  function  are  produced,  or  (and 
this  is  where  the  difficulty  comes  in,  in  practice), 
according  to  the  possibly  differing  views  of  different 
advisers  as  to  their  mode  of  production,  Evidently 
if  a  condition  is  caused  by  paralysis  or  loss  of  power 
in  one  set  of  nerves,  its  treatment  mu^  be  by 
attempting  to  strengthen  the  same ;  but  if,  on  the 
other  hand,  it  is  caused  by  over- stimulation  of 
another  set,  equally  clear  is  it  that  the  object  of 
treatment  ought  to  be  to  remove  some  of  the  excess 
of  action.  On  the  former  view  the  action  must  be 
tonic,  bracing,  strengthening ;  on  the  latter  it  must 
be  lowering,  relaxing,  weakening.  There  can  be  no 
doubt  that  much  difficulty  enters  here  into  medical 
practice,  but  I  should  like  to  add  that  the  difficulty 
is  by  no  means  confined  to  medicine ;  commercial, 
social  and  ethical  relations  presenting  frequently 
the  same  difficulties. 

Simple  as  they  are,  the  discussion  of  the 
proximate  causes  or  states  has  led  us  further  than 
we  expected,  and  has  opened  up  a  field  much  wider 
and  more  difficult  than  we  supposed.  The  exciting 
causes  will  hardly  detain  us  long.  These  are  such 
influences  as  heat,  wetness,  dryness,  calm,  wind, 
storm,  and  so  on ;  also  organic  micro-organisms, 
spores,  germs  and  organic  particles ;  and,  lastly, 
violence  of  various  kinds.  The  effects  of  the  last 
are  dealt  with  by  the  surgeon ;  those  of  the  others 
by  the  physician  for  the  most  part.  It  is  very 
difficult  to  differentiate  by  exclusive  characteristics 
the   exciting   causes    from   the    predisposing,    with 


88 

which  I  must  deal  directly  ;  but  probably  as  good  a 
means  of  differentiation  as  any  would  be  to  say 
that  while  the  exciting  causes  act  once  or  seldom, 
the  predisposing  act  often  or  for  a  long  period  of 
time.  An  attempt  to  distinguish  the  one  set  of 
causes  from  the  other  shews  that  causes  which  are 
considered  to  be  exciting  from  one  point  of  view 
may  become  predisposing  from  another.  For 
instance,  getting  one's  feet  wet  on  a  given  occasion, 
or  being  in  a  wind,  may  be  the  exciting  cause  of 
an  attack  of  inflammation  of  the  lungs  or  of 
bronchitis ;  but  being  more  or  less  continually 
exposed  to  the  effects  of  damp  or  draughts  may  act  as 
a  predisposing  cause  to  some  long-continued  illness. 
The  predisposing  causes  of  disease  are  for  the 
most  part  the  relations  of  the  body  to  air,  to  food, 
and  to  exercises,  with  perhaps  the  influences  of 
anxiety  and  of  heredity  added.  I  shall  hope  to  say 
something  about  the  last  later,  and  shall  dismiss  it 
for  the  present  with  the  remark  that  as  a  cause  of 
disease  (though  not  of  organisation,  which  is  greatly 
determined  by  it)  I  believe  its  influence  has  been 
greatly  exaggerated  both  by  medical  men  and  by 
the  general  public.  And  I  go  on  to  say  that  of 
the  other  predisposing  causes  of  disease  by  far 
the  most  important  is  the  relations  of  the  body  to 
food.  This  statement  is  really  the  main  thesis  of 
this  essay.  This  thesis  may  be  analysed  into  the 
following  statements.  First,  if  human  beings  were 
to  arrange  properly  the  quantity  and  quality  of  the 
food  which  they  take,  and  also  the  times  at  which 


89 

they  take  it,  they  would  suffer  much  less  from 
disease  and  illness  than  they  do  now.  Second,  even 
after  disease  has  occurred  or  has  broken  out,  the 
best  means  to  combat  it  and  to  restore  the  body  to 
health  is  by  an  alteration  in  the  diet.  From  which 
it  follows,  thirdly,  that  the  best  and  most  important 
means  to  keep  a  man  in  the  health  which  by  the 
supposition  he  has  re-attained,  is  to  prescribe  for 
him  a  proper  amount  and  quality  of  food,  and 
suitable  times  of  taking  it  for  the  future. 

A  great  Latin  medical  writer,  it  is  well  known, 
divided  methods  of  treatment  into  three  divisions, 
treatment  by  diet  {victus),  by  medicines  {medica- 
menta),  and  by  surgery  (manus).  And  he  might 
have  added,  I  venture  to  suggest,  that,  with  the 
exception  of  a  few  diseased  conditions  which  mtist 
be  treated  by  surgery,  those  diseases  which  cannot 
be  treated  by  diet  or  by  diet  combined  with 
exercises,  which  for  the  moment  he  forgot,  ca.n 
hardly  be  ejB&ciently  treated  at  all. 

These  positions  must  not  be  understood.  It  is 
not  contended  that  the  relations  of  the  body  to 
food  are  the  only  causes  of  disease.  It  is  most 
freely  admitted  that  there  are  other  causes.  No 
sensible  man  would  deny  or  would  wish  to  deny 
that  the  relation  of  the  body  to  air  or  respiration  is 
a  very  important  cause  of  health  on  the  one  hand, 
and  of  disease  on  the  other.  Nor  would  he  fail  to 
attribute  an  important  influence  to  the  effects  of 
exercise  on  the  body.  Among  the  exciting  causes 
of  disease,  again,  long  exposure  to  cold  or  to  heat. 


90 

or  to  fatigue,  or  to  anxiety,  as  to  many  of*  the 
other  exciting  causes,  must  and  does  exert  a  very 
powerful  influence  for  good  or  evil  on  health  or 
disease.  But  after  all  these  admissions  are  made, 
and  due  allowance  made  for  the  undoubted  effect  of 
these  other  causes  in  affecting  the  body  for  good 
and  ill,  the  statement  still  seems  to  the  writer  to 
hold  good  that  by  far  the  most  potent  cause  of 
disease,  the  cause  compared  with  which  all  the  rest 
pale  into  insignificance,  is  the  predisposing  cause  of 
improper  food  supply,  either  as  to  quality  or 
quantity,  or  both.  How  greatly  this  cause  pre- 
ponderates it  is  difficult  to  say,  but  the  writer  is  of 
opinion,  for  reasons  which  will  appear  abundantly 
in  the  sequel,  that  it  would  probably  be  no 
exaggeration  to  say  that  proper  or  improper 
relations  between  the  body  and  food  are  as  great 
and  important  causes  of  health  and  disease  as  all 
other  causes  put  together.  The  precise  proportion, 
however,  by  which  this  cause  preponderates  over 
the  others  is  immaterial  to  the  argument,  which 
alleges,  on  the  other  hand,  that  it  is  by  far  the 
most  important  cause,  but  by  no  means  that  it  is 
the  only  one.  A  man  may  undoubtedly  be  worried 
to  death,  may  be  broken  down  by  sorrow  and 
anxiety,  and  his  life  and  spirit  worn  down  by 
this  cause,  however  properly  he  may  manage  his 
digestion  and  food  arrangements.  And,  on  the 
other  hand,  so  may  he  be  chilled  or  destroyed  by 
excessive  and  long  continued  cold  or  heat,  or 
exposure,  or  overwork. 


91 

This  will  probably  be  the  best  place  in  which 
to  introduce  some  ideas  which  we  must  consider 
sooner  or  later,  regarding  the  division  of  diseases 
into  acute  and  chronic.  Under  the  action  of  such 
an  exciting  cause  as  exposure  to  cold,  or  wetness, 
or  wind,  a  person  is  very  apt  to  have  a  feverish 
attack,  or  an  attack  of  inflammation,  as  it  is 
called,  in  some  organ  or  part.  When  this  happens 
the  temperature  usually  is  found  to  rise  above  the 
normal  standard  of  98*4°  F.  (37°  C),  and  the  pulse 
is  generally  found  beating  at  a  higher  rate  than  the 
60-90  beats  a  minute,  which  we  laid  down  as  the 
usual  limits  of  health.  The  increase  of  the  pulse- 
rate,  and  the  elevation  of  the  temperature  are  the 
signs,  or  some  of  them,  by  which  nowadays  we 
measure  the  acuteness  or  severity  of  an  illness. 
Formerly  it  was  not  so.  The  ancient  physicians 
did  not  measure  temperature,  although  they  put 
their  hands  on  patients'  bodies  to  feel  if  they  were 
hot ;  nor  do  they  seem  to  have  counted  the  pulse, 
although  they  examined  the  pulse  carefully,  and 
attached  great  importance  to  its  changes,  and  this 
notwithstanding  that  they  did  not  realise  or  under- 
stand the  circulation  of  the  blood  and  lymph.  The 
severity  or  acuteness  of  a  disease  seems  to  depend 
on  two  things ;  first,  the  amount  or  quantity  of  the 
exciting  cause,  the  amount  of  the  cold,  or  wind,  or 
wetness,  etc, ,  to  which  a  person  may  be  exposed  ; 
and  second,  the  strength  or  weakness  of  the 
patient.  We  should  now  say  that  the  severity  of 
an  illness  or  its  acuteness,  as  well  as  the  length  of 


92 
its  duration,  are  proportional  to  the  quantity  of 
the  cause  in  action,  and  that  it  is  inversely  as  the 
resistance  of  the  person  acted  upon,  or  (what  comes 
to  the  same  thing)  proportional  to  his  weakness  or 
his  predisposition  to  disease.  An  acute  disease  is 
generally  a  rather  short-lived  one,  while  milder 
diseases  are  generally  longer  in  duration ;  and 
hence  it  is  customary  to  classify  diseases  into  acute 
or  severe  on  the  one  hand,  and  into  chronic  on  the 
other.  It  is,  however,  many  years  since  I  have 
been  attempting  to  draw  attention  to  the  fact 
which  I  must  emphasize  again,  that  acute  and 
chronic  are  not  logical  opposites.  Acute,  in  fact,  is 
opposed,  not  to  chronic,  but  to  mild ;  and  between 
acute  and  mild  there  may  be,  and  often  is,  inserted 
an  intermediate  group  or  class  of  diseases,  viz.,  the 
sub-acute',  while  beyond  the  acute  diseases  it  is 
not  infrequently  necessary  to  distinguish  those 
which  are  extremely  severe,  or  per-acute*  as  they 
have  been  termed.  Chronic,  on  the  other  hand,  is 
the  opposite,  not  of  acute,  but  of  short.  The 
division  of  diseases  into  acute  and  chronic  was 
introduced  by  Asclepiades  of  Prusa,  who,  after  he 
went  to  Rome,  became  the  medical  adviser  of 
Cicero.  He  was  not  a  doctor,  properly  speaking,  at 
all  (of  the  rank,  for  instance,  of  Celsus  or  Galen) 
but  a  philosopher  or  dialectician.  His  contribution 
to  medicine,  of  this  very  division  of  diseases  into 
acute  and  chronic,  as  also  his  distinction  between 

*  The  term  ultra-acute,  suggested  recently,  seems  to  have  been  proposed  in 
ignorance  of  the  existence  of  the  much  better  and  time-honoured 
term  per-acute . 


93 

category  and  prosagory,  as  well  as  his  ideas 
regarding  the  oyKoi  (Latin,  Unci)  or  hooked  atoms, 
a  possible  anticipation  of  the  modern  doctrine  of 
microbes,  and  of  the  part  they  may  be  supposed  to 
play  in  the  causation  of  disease,  all  bear  the  impress 
rather  of  the  philosopher  than  the  practical 
physician.  His  division  of  diseases  into  acute 
and  chronic,  however,  has  been  most  unfortunate, 
and  offers  one  of  the  most  interesting  instances  of 
an  alleged  reform  being  really  a  retrogression, 
because  it  can  be  shewn  that  Hippocrates,  hundreds 
of  years  before,  had  spoken  of  diseases  as  being 
mild  {rrpaeis)  and  severe  or  acute  (o^et?)  and  had 
also  spoken  of  diseases  as  being  short  {/Spaxel'?  or 
6XLyo-)(p6vLOL)  and  /ong  (ttoXv^ovlol  or  yjpovioi  or 
[MaKpol),  so  keeping  things  which  were  distinct  in 
fact,  clear  and  distinct  in  his  mind  and  in  language. 
And  yet  the  so-called  reform  of  Asclepiades  has 
held  its  own  ever  since  his  time,  displacing  the 
more  logical  ideas  of  Hippocrates  in  this  particular. 
In  Latin  the  word  lentus  is  often  used  of  the 
chronic  diseases.  As  lentus  means  tenacious,  hence 
slow,  sluggish,  hence  lasting,  and  as  long  diseases 
are  generally  somewhat  mild,  there  has  been  no 
relief  to  the  ambiguity,  derived  from  the  use  of 
Latin  terminology,  such  e.g.,  as  the  use  of  the 
word  mitis  for  mild  or  slight  would  have  given  us. 

Chronic  means  long  continued,  and  the  term 
has  been  applied  to  any  diseased  state  of  the 
organism  lasting  for  twenty-eight  days  or  longer. 
To  lengthen  its  application  or  definition  to  diseases 


94 

lasting  three  months  would,  I  think,  be  better, 
because  a  few  cases  of  what  is  called  acute  disease 
last  as  long  as  three  months  (some  even  more),  e.g., 
some  cases  of  typhoid  fever,  which  certainly  go  on 
occasionally  for  six,  nine,  or  twelve  weeks,  or  longer ; 
or  cases  of  rheumatic  fever.  No  doubt  chronic 
diseases  are  generally  mild,  but  frequently  they  are 
not  so,  being  sub-acute  or  acute,  or  even  per-acute 
(in  accordance  with  the  definitions  immediately 
to  be  given  to  these  terms),  while  more  often  they 
are  alternately  mild  at  some  periods  of  their  course, 
and  acute  or  sub-acute,  or  per-acute  at  others.  Or 
they  may  be  intermittent  or  recurrent  ;  that  is, 
they  may  cease  entirely  for  a  time,  during  which 
the  patient  gets  quite  well,  and  then  they  may 
recur.  Again,  disease,  without  entirely  ceasing, 
may  improve  considerably,  becoming  milder  for  a 
time,  and  then  become  more  severe  again  ;  in  which 
case  it  is  termed  remittent  rather  than  intermittent. 
But  when  disease  settles  down  on  a  patient,  or,  as  it 
may  be  better  expressed,  when  the  patient  is  always 
ill,  for  as  long  (I  propose)  as  not  less  than  three 
months  at  a  time,  then  his  disease  is  termed  chronic. 
Even  in  this  last  case,  however,  when  patients  are 
always  ill,  they  are  not  equally  ill  at  all  times,  for, 
if  the  case  is  watched  closely,  it  will  always  be 
found  that  the  patient  is  worse  at  some  times  and 
not  so  ill  again  at  others.  We  may  otherwise 
express  this  state  by  saying  that  a  patient  is 
recurrently  or  intermittently  ill,  and,  by  and  bye, 
that    he    is    remittently    ill,    before    he    becomes 


95 

chronically    ill.       The    cause    of    this    alternation 
between  being  better  and  worse  or  between  being 
ill    and    again   not    so    ill,    is   a    very   interesting 
one.     I  believe  it   depends  on  the  manner  of  the 
rotation  of  the  earth   on   which    we   live,    and   its 
behaviour  to  the  sun  ;  for  that  arrangement  implies 
that   our  earth,  in  revolving  on   its  axis,   projects 
now  this  side   and  then   that    to  the  sun,  so   that 
in  the  former   case  it  is  day  on  one  part  of  the 
planet  and  night  on  the  other,  and  in  the  course  of 
twelve   hours   or  so   these   relations   are   reversed. 
Now,  when   it   is   day,   on    a   certain   part   of  the 
planet,  all  organic  things  on  that  part  are  shrunk 
and  ready  for  action  like  a  spring  compressed  which 
is  ready  to  uncoil  as  the  day  goes  on ;    till,  when 
night  comes  on,  they  are  swollen  like  an  uncoiled 
spring   and   go   to    sleep,    during   which   time   the 
spring  becomes  shrunk  again,  or  compressed,  as  it 
were,  and  is  ready  on  another  day  to  translate  its 
uncoiling  into   the  doing   of  physical  and   mental 
work.     The  effect  of  this  arrangement  is  to  produce 
the   intermittent   work    or   action  as  distinguished 
from   constant    or  continuous   action,  which   is    so 
characteristic   of    everything   that    occurs   on   this 
planet,  that  all  action  is  intermittent  and  even  what 
seems   to    be    continuous    action,    translates    itself 
always    into    a    rapid    succession    of    intermittent 
actions.     Hence  the   alterations  of  pulse-rate  and 
temperature  which  we  observe,  not  only  in  disease 
but  even  in  health  to  some  extent  ;  and  hence  also 
those  alternations  which  invariably  occur  in  all  the 


96 


relations  of  man  to  his  environment,  traceable,  as 
they  are,  in  politics,  commerce,  and  philosophy,  and 
which  determine  the  behaviour  even  of  the  ultimate 
elements  of  protoplasm,  so  that  they  are  seen, 
whether  by  the  naked  eye  or  under  the  microscope, 
to  be  in  constant  alternation  of  swelling  on  the  one 
hand  and  shrinking  on  the  other.  Even  inorganic 
phenomena  manifest  this  characteristic,  and  the 
very  tide  rises  and  falls  in  an  intermittent  and  not 
in  a  continuous  way,  alternately  rising  and  falling 
as  it  flows,  and  falling  and  rising  as  it  ebbs.  It  is 
an  interesting  speculation,  and  one  not  wholly 
unpractical,  to  inquii'e  what  would  be  the  effect  on 
life  and  on  phenomena  on  a  planet  which  should 
behave  differently  to  the  sun,  as  the  moon,  for 
instance,  behaves  to  the  earth,  rotating  on  its  axis, 
indeed,  but  in  such  a  way  as  to  keep  always  the 
same  face  to  the  sun.  Obviously  there  would  be 
everlasting  day  on  one  side  of  such  a  planet,  and 
everlasting  night  on  the  opposite  one ;  and  the 
effect  on  Hfe  and  on  every  action  occurring  on  that 
planet  would  probably  be  very  different  indeed 
from  what  occurs  on  our  earth.  It  seems  as  if  the 
diagrammatic  representation  of  life  in  this  latter 
case  would  be,  not  as  with  us,  a  zig-zag  line  repre- 
senting a  rise  and  fall,  thus — 


but  would  be,  on  the  contrary,   represented  by  a 


97 


point  which  widens  into  a  line,  the  hne  widening  to 
its  broadest  place,  after  which  it  would  begin  to 
become  narrower  and  narrower  till  it  ended  in  a 
point  again,  thus — 


and  probably^  the  action  of  life  on  such  a  planet 
would  be  continuous,  and  not  intermittent  as  on 
ours,  beginning  with  slight  actions,  which  would 
become  stronger  and  stronger,  till  they  culminated 
at  the  central  point  in  the  double  cone,  after  which 
they  would  generally  diminish,  but  still  in  a  con- 
tinuously lessening  manner,  till  they  finally  ended 
in  a  point  as  they  began. 

But  however  this  may  be,  and  to  return  to  our 
consideration  of  acute  and  chronic,  when  we  reflect 
that  chronic  diseases  are  severe  enough,  or  acute 
enough  to  kill  patients,  we  seem  to  realise  better 
the  confusion  which  exists  in  our  minds  in  thinking 
about  them.  Chronic  being,  then,  the  opposite, 
not  of  acute,  but  of  short  or  brief,  we  can  define  a 
short,  or  brief,  or  brachy-chronic  disease  {vov(To<i 
fipa)(yxpo^i^o^>  or  morbus  brevis),  as  one  lasting,  I 
would  suggest,  not  longer  than  three  months.  If 
it  lasted  longer  than  this,  it  would  be  chronic 
(vovcros  ^6vL0<i,  or  Trokxxxpovio's,  or  jxaKpb^s,  morbus 
longus  or  chronicus).  Then  a  rather  short  disease 
(i/ov<Tos  ^pa)(y)(f>ovL(oTepa,  or  morbus  brevior)  would 
be  defined  as  one  lasting  14  days  or  so ;  while  a  very 


98 

short  disease  {vov(ro<;  ^paxyxpovLtoTara,  or  morbus 
brevissimus),  would  be  one  which  lasted  from  two 
to  seven  days.  A  disease  lasting  one  day  has  often 
been  termed  ephemeral  (j/ovcro?  i^rjixepios,  or  morbus 
dturnus).  Diseases  which  recurred,  on  the  other 
hand,  at  daily  intervals,  or  at  intervals  of  two  or  of 
three  days,  were  called,  respectively,  quotidian, 
tertian,  and  quartan  diseases.  In  the  opinion  of 
Asclepiades  of  Prusa,  the  differences  in  the  length 
of  the  duration  of  these  last  diseases  were  determined 
by  differences  in  the  sizes  of  the  oy/cot,  or  unci, 
or  hooked  atoms  co-existing  with  them,  a  doctrine 
which,  as  has  been  said,  may  be  considered  anticipa- 
tory 1800  years  ago,  of  the  germ  theory  of  disease, 
of  which  we  have   heard  so  much  of  late  years. 

Acute  or  severe  diseases  {vovaoi  6^el<s,  or  morbi 
acuti),  on  the  other  hand,  may  be  defined  as  those 
in  which  the  pulse-rate  reaches,  say,  120  or  130  a 
minute,  and  the  temperature,  say  102*5°  to  104°  F. 

Peracute  diseases  (vovcroL  o^vrdrai  or  vTrepo$ei<;, 
or  morbi  per acuti),  are  those  in  which  the  pulse 
reaches  130  a  minute  or  over,  and  the  temperature 
is  over  104°  F.  (Sometimes  the  temperature  does 
not  rise  in  these  diseases,  being  kept  down  by 
failure  or  inability  of  the  body  to  react,  or  by  too 
great  shock.)  In  mild  diseases  {yovcroi  Trpaets,  or 
morbi  mites  or  lenti),  the  pulse  is  not  more  rapid 
than  about  100  a  minute,  and  the  temperature  not 
above  99-5°  or  100°  F. 

Acuteness  of  disease,  therefore,  depending  on 
its  severity  and  not  on  the  length  of  its   duration, 


99 

its  opposite  is  mildness,  not  length  of  duration. 
And  a  subdivision  might  be  made,  and  often  is 
made,  between  acute  and  mild  diseases,  of  the 
subacute  diseases  (vovo-ol  vno^eis,  or  morbi 
subacuti),  in  which  the  pulse-rate  will  be  about  110 
to  120,  and  the  temperature  between  100°  and  102° 
F.,  or  so. 

Diseases   which  are  severe,   or  acute,   or  per- 
acute,  are  generally  also  short,  because  the  human 
body   cannot   bear   very   severe   suffering   for    any 
great  length  of  time  without  either  relief  or  death  ; 
and  this  has  no  doubt  been  the  chief  determining 
consideration  which  has  led  in  men's  minds  to  the 
confusion  in  classification  into  the  acute  and  chronic 
diseases.     I  said  that  Hippocrates  was  much  clearer 
in   his  ideas  on   this    subject,   and   in   his    use    of 
language    regarding    it,     than    was    his    successor 
Asclepiades  of  Prusa ;  and  this  is  true.     But  even 
Hippocrates  was  not  always    quite    clear    on   the 
point,  and  in  one  of  his  aphorisms,    he  says,  that 
acute  diseases  can  be  judged  or  determined  (by  the 
observer)    in    fourteen    days — a   most   unfortunate 
expression,  as  it  happens,  since  it  has  been  supposed 
to  mean  that  he  defined  acute  diseases  as  those  that 
last    fourteen    days,    so  justifying    that     confusion 
between  severity  and  length  of  duration  in  diseases 
which  has  obtained  for  so  long  a  time.     The  words 
of     Hippocrates    are,     ra  o^ea    raiv    vocnqfidTOiv    iv 
TecrcrapecTKaLSeKa   rjfjLepyjo-Lv  KpiveTai.     Here   a   good 
deal   may  turn  on  the  meaning  we  attach  to  the 
word    KpLverai.       It    seems,    however,    clear    that 

G2 


100 

what  Hippocrates  did  mean  was,  not  that  acute 
diseases  were  those  that  last  fourteen  days,  but 
this,  that  in  fourteen  days  the  observer  will 
generally  be  able  to  determine  what  sort  of  disease 
his  patient  is  suffering  from,  and  what  the  issue  is 
likely  to  be ;  whether  the  illness  is  likely  to  be 
long  or  short,  and  also  whether  it  is  likely  to  be 
fatal  or  otherwise.  These  propositions  are  true 
enough  ;  and,  in  fact,  we  can  usually  form  opinions 
on  these  points  before  even  fourteen  days  have 
elapsed  from  the  commencement  of  the  illness  we 
may  be  treating.  But  while  we  must  admit  that 
Hippocrates  was  not  always  quite  clear  in  his 
language  regarding  acute  and  mild  diseases  on 
the  one  hand,  nor  as  to  short  and  long  ones  on  the 
other  (see,  for  instance,  a  passage  in  Trepl  Kpia-luiv, 
where  he  says  that  diseases  Kplvovrai  up  till  the 
sixtieth  day,  after  which  they  become  chronic), 
his  confusion  was  never  so  dark  as  that  of  the 
so-called  reformer  who  came  after  him,  and  who 
misled  his  successors  in  turn.  The  remarks  made, 
and  the  descriptions  suggested  for  mild  and  acute, 
and  lon^  and  short  conditions  will,  it  is  hoped,  show 
how  a  disease  may,  in  its  course,  be  now  acute,  and 
then  mild,  and  again  sub -acute,  and  that  these 
conditions  have  no  necessary  connection  with  the 
length  of  its  duration ;  and  they  will,  I  hope, 
therefore,  have  proved  that  the  division  of  diseases 
into  acute  and  chronic  is  not  a  logical  one,  and  that 
it  ought,  therefore,  to  be  superseded  by  one  more 
in  accordance  with  the  order  of  nature. 


101 

I  hope  to  be  able  to  adduce  evidence  which 
offers  a  reasonable  amount  of  proof  for  the  correct- 
ness of  the  view  I  put  forward  that  wrong  feeding 
is  the  chief  or  paramount  cause  of  disease,  both 
acute  or  mild  on  the  one  hand,  and  chronic  or  brief 
on  the  other.  This  evidence  should  be  capable  of 
receiving  corroboration  in  three  directions.  First, 
it  is  easy  to  shew  that  all  diseases  are  most  easily 
treated  by  alteration  of  the  diet.  This  statement 
will  hardly  be  disputed.  By  common  consent  it  is 
true,  and  common  practice  bears  it  out.  In  fact, 
alteration  of  the  diet,  and  almost  always,  or  at 
least  very  frequently,  restriction  of  the  diet,  is 
nature's  method  of  cure.  Certainly  in  all  acute 
diseases  this  is  so  much  the  case  that  restriction  of 
the  diet,  and  often,  indeed,  entire  abstinence  from 
food,  is  the  treatment  adopted  by  nature.  In  these 
diseases  she  flings  the  patient  into  bed  with  a  furred 
tongue,  or  dry  and  brown  tongue  and  mouth,  with 
complete  inability  to  take  any  food,  and  very  often 
also  complete  refusal  to  take  it,  or  to  digest  and 
assimilate  it,  if,  in  spite  of  her  clear  indications,  it 
is  taken.  Second,  it  can  be  shewn  in  most  cases 
that,  this  disinclination  to  take  food  persisting  for  a 
time,  the  patient  recovers,  and  remains  well  so  long 
as  he  continues  to  take  proper  quantities  of  food  at 
proper  times.  Thirdly,  it  will  be  shewn  in  so  many 
cases  as  to  raise  a  reasonable  presumption  that  it  is 
the  rule  in  the  body,  that  disease  is  re-induced  in 
those  cases  in  which  return  is  made  again  to  those 
methods   of    feeding   which   made   the    patient   ill 


102 

before.  I  do  not  myself  believe  that  the  fevers 
which  are  generally  supposed  to  be  caused  by  bad 
or  vitiated  air  ofter  any  exception  to  this  statement. 
I  think  that  the  chief  predisposing  cause  of  them, 
as,  e.g.,  of  measles,  scarlatina,  diphtheria,  typhoid 
fever,  influenza,  and  the  rest,  is  improper  feeding,  and 
chiefly  over-feeding.  It  is  true  that  it  is  difficult 
to  shew  this  in  the  case  of  the  continued  fevers, 
because,  as  a  rule,  these  diseases  occur  only  once  in 
life.  Although  they  seem  to  me  to  occur  offcener 
than  once  in  life,  more  frequently  than  is  commonly 
believed — how  often  do  we  find  patients  having 
more  than  one  attack  of  measles  or  scarlet  fever 
(scarlatina),  for  instance — I  admit  that  recurrence 
is  exceptional,  and  that  as  a  rule  they  occur  only 
once.  This  is  not  true,  however,  of  influenza,  which 
is  properly  classed  among  the  fevers.  The  definition 
which  I  should  ofler  of  the  zymotic  diseases  (^u/aog>, 
=  I  leaven  or  make  to  ferment),  or  of  the  fevers 
(ferveo  —  I  burn)  is  that  they  are  febrile  diseases 
known  or  believed  to  be  associated  with  the 
presence  and  growth  of  micro-organisms  in  the 
blood  or  tissues  of  the  body.  Inflammations,  on 
the  other  hand  (flamma  —  a  flame),  might  be 
defined  as  febrile  diseases  not  known  to  be  associated 
with  the  presence  and  growth  of  such  micro- 
organisms. Some  inflammations,  it  is  true,  are 
believed  to  be  associated,  or  are  suspected  to  be 
associated,  with  the  presence  and  growth  of  micro- 
organisms in  the  body.  Some  forms  of  pneumonia, 
for   instance,    or    inflammation   of    the    lungs,    are 


103 

now  known  to  be  so  associated ;  while  lately,  as 
regards  acute  rheumatism,  or  rheumatic  fever,  as  it 
is  more  frequently  called,  the  same  suggestion  has 
been  made,  or  the  same  suspicion  entertained. 
Such  inflammations  are  often  termed  specific 
inflammations,  and  of  them  it  may  be  said  that 
medical  opinion  is  tending  towards  including  and 
classifying  them  among  the  fevers.  But  at  present 
we  may  say  that  the  specific  inflammations  form  a 
group  of  diseases  between  the  fevers  and  the  simple 
inflammations.  As  regards  these  last  diseases, 
indeed,  the  simple  inflammations,  I  should  not  be 
greatly  surprised  if  it  should  be  found  before  long, 
as  the  knowledge  of  the  life  history  of  the 
numerous  micro-organisms  becomes  more  thoroughly 
known,  that  more  and  more  of  the  inflammations 
will  be  found  to  be  associated  with  the  growth  in 
the  body  of  some  forms  of  micro-organisms.  In 
this  case  the  distinction  between  the  fevers  and  the 
inflammations  would  tend  to  become  obHterated. 
Up  to  the  present  time,  however,  this  association  of 
the  growth  of  micro-organisms  has  not  been  shewn 
in  the  case  of  the  simple  inflammations,  such,  for 
instance,  as  bronchitis,  simple  broncho-pneumonia, 
or  in  such  afiections  as  inflammation  of  the  heart, 
stomach,  liver  or  kidneys,  and,  therefore,  the 
distinction  between  the  fevers  and  the  inflamma- 
tions still  holds  good.  And  further,  the  clinical 
distinction  between  the  fevers  and  the  inflammations, 
that  the  former  appear  only  once  in  life  while  the 
latter   may  and   often   do  occur  again   and   again, 


104 

holds  true  in  the  main.  It  is,  therefore,  very 
diflficult  to  prove  the  third  part  of  our  argument  in 
the  case  of  the  fevers,  viz.,  that  a  recurrence  to 
those  modes  of  feeding  which  induced  them  at  first 
will  re-induce  them.  In  the  case  of  influenza, 
however,  this  difficulty  does  not  occur.  Influenza 
belongs  to  the  fevers,  because  the  micro-organism 
associated  with  its  occurrence  in  the  body,  has  been 
cultivated  and  developed  again  and  again.  I  have 
no  doubt  at  all  that  the  chief  predisposing  cause  of 
influenza  is  wrong  feeding  and  too  frequent  feeding ; 
and  the  kind  of  evidence  which  I  ofier  for  the 
holding  of  this  opinion  is  represented  by  cases  like 
the  following.  A  man  about  38  years  of  age 
consulted  me  for  frequently  recurring  attacks  of 
broncho-pneumonia,  or  severe  feverish  colds,  as  they 
are  popularly  termed,  and  mentioned  also  that  he 
had  had  influenza  in  three  consecutive  years.  He 
ofiered  to  go  to  South  Africa  or  anywhere  where  I 
might  think  he  would  have  a  better  chance  of 
living  a  healthy  life,  if  only  he  could  be  rid  of  his 
crippling  attacks  of  illness.  I  told  him  that  he 
might  go  to  South  Africa  if  he  liked,  but  that,  in 
my  opinion,  he  could  get  well  in  Bradford  if  he 
would  take  a  little  trouble.  Further,  I  said  that  if 
he  did  go  to  South  Africa,  and  if  he  got  rid  of  his 
severe  and  recurring  colds  there,  and  if  he  did  not 
in  the  meantime  alter  his  ways,  and  particularly  his 
food  habits  (there  was  no  suggestion  of  alcoholism 
in  the  case,  the  man  being,  if  not  a  teetotaller,  very 
temperate),  the  colds  would  infallibly  be  replaced 


105 

by  some  other  form  of  illness,  rheumatism,  e.g.^  or 
gout,  or  perhaps  by  the  onset  of  some  disease 
generally  attributed  to  the  South  African  climate. 
In  short,  I  told  him  that  it  mattered  far  less  where 
he  lived  than  hoiso.  I  advised  him  to  cut  down  his 
food,  which  he  evidently  was  not  assimilatiug,  and 
in  particular  to  take  two  meals  daily  in  place  of 
three,  and  I  suggested  that  he  should  diminish  his 
bread.  The  effect  of  these  changes  has  been  most 
beneficial.  After  one  other  broncho  -  pneumonic 
attack,  whose  effect  was  most  salutary  to  him,  as  it 
helped  to  rid  his  body  of  the  accumulation  of  effete 
and  unassimilated  stuff  which  was  stored  up  within 
it,  he  has  remained  now  free  of  his  old  ' '  colds  "  for 
about  four  years ;  and  he  has  not  had  influenza 
since.  As  these  advantages  were  confidently  pre- 
dicted to  him  as  consequences  which  would  ensue 
on  the  alteration  of  his  food  habits,  and  as  they 
have  accrued  to  him  accordingly  on  his  effecting 
that  alteration,  I  have  no  doubt  that  his  colds  and 
his  influenzas  were  dependent  on  the  wrong  feeding 
to  which  he  used  to  be  subject.  If  this  is  so,  we 
have  a  recurring  inflammation,  and  also  a  fever,  put 
an  end  to  by  alteration  of  the  diet,  and  particularly 
by  restriction  of  the  diet.  If  the  man  has  any 
doubt  of  the  sequence  of  cause  and  effect  in  the 
case,  he  has  only  to  return  to  his  former  way  of 
living ;  which,  if  he  did,  I  have  no  doubt  that  in  a 
few  weeks  he  would  get  another  attack  of  broncho- 
pneumonia, and,  no  doubt,  after  some  time  longer, 
would  again  find  himself  suffering  from  influenza. 


106 

But  I  do  not  recommend  that  this  experiment 
should  be  made,  although  I  have  no  doubt  (neither 
has  my  patient,  to  whom  the  whole  matter  has  been 
a  great  surprise)  what  the  result  would  be  if  it 
were.  The  same  experience  occurred  to  me  in 
treating  a  patient  who  had  suffered  for  many  years 
from  a  succession  of  bronchitic  and  asthmatic 
attacks.  He  had  lived  in  the  West  Indies  for  some 
years,  some  thirty  years  before  the  time  to  which  I 
am  now  referring.  While  there  he  had  suffered 
greatly  from  malarial  fever,  ' '  fever  and  ague, "  as 
it  was  termed  there,  and  so  profoundly  had  his 
organism  become  modified  that  he  never  took  one 
of  his  many  and  continually  recurring  colds  without 
suffering  also  from  an  attack  of  ague.  Being 
advised  to  restrict  his  diet  in  order  to  get  rid  of 
his  bronchitis  and  asthma,  and  having  done  as  he 
was  advised,  he  made  a  complete  recovery,  not  only 
from  the  bronchitis  and  asthma,  but  also  from 
chronic  rheumatism,  from  which  he  used  to  suffer, 
as  well  as  recurring  attacks  of  herpes,  or  watery 
blisters,  on  his  lips,  mouth  and  tongue.  And,  still 
further,  to  the  surprise  both  of  the  doctor  and  of 
the  patient,  he  has  not  now  had  an  attack  of  ague 
for  over  ten  years.  It  really  does  seem  marvellous 
that  so  marked  and  so  gratifying  a  result  as  this 
could  occur  after  about  fifty  years  of  age,  and  after 
the  body  had  suffered  for  so  long  a  time  as  thirty 
years  ;  but  so  it  was.  That  patient  would  be  very 
ill-advised  if  he  were  to  carry  scepticism  as  to 
whether  his  recovery  depended  on  the  treatment,  so 


107 

far  as  to  have  recourse  again  to  the  mode  of  feeding 
which  made  him  so  ill  before.  Nevertheless,  if  he 
were  to  do  so,  I  have  no  doubt  that  he  would  soon 
again  begin  to  suffer  from  herpes  of  the  lips,  from 
rheumatism,  from  bronchitis  and  asthma,  and,  by 
and  bye,  even  from  recurring  ague.  But  as  malarial 
fever  and  ague  is  technically  a  fever,  here  is  another 
case  in  which  an  alteration  of  the  food  habits  and 
restriction  of  the  diet  have  cured  and  prevented 
the  recurrence  both  of  inflammations  and  of  fever. 

I  can  imagine  some  reader  here  saying  to 
himself,  why  was  not  quinine  administered  to 
this  patient  "to  break  the  periodicity  of  his 
attacks  ?  "  It  is  well  known,  I  hear  him  mentally 
adding,  that  quinine  is  specific,  and  a  sovereign 
remedy  in  intermittent  fever.  Alas  for  the 
suggestion — quinine  was  administered,  and  that  in 
large  doses.  Often  had  he  been  cinchonised  while 
in  the  West  Indies  by  the  quinine  which  he  took. 
On  one  occasion  he  took  120  grains  of  quinine  in 
three  weeks,  but  without  any  noticeable  effect  on 
his  intermittent  fever.  Then  he  was  recommended 
to  take  arsenic,  which  did  him  good  for  a  time,  but 
the  attacks  recurred,  because  the  causes  of  the 
attacks,  viz.,  improper  feeding,  continued  to  act. 
It  is  easy  to  see  this  now,  but  no  one  had  the  ghost 
of  an  idea  of  it  then.  It  had  never  occurred  to 
anyone  interested  in  the  case  that  food  had 
anything  to  do  with  it,  and  the  illness  was 
attributed  wholly  to  the  West  Indian  climate. 
Nevertheless,  it  is  plain  now,  on  looking  back,  that 


108 

it  had  everything  to  do  with  it,  and  that  a  cause 
acting  constantly,  or  at  least  at  very  short  intervals 
of  time  (three  or  four  or  more  times  a  day),  shewed 
its  effects  in  intermittent  or  periodic  attacks  of  ague, 
separated  from  one  another  by  longer  intervals  of 
time.  This  is  in  perfect  accordance  with  the  law 
elsewhere  stated  that  constant  causes  acting  on  the 
economy  shew  their  influence,  not  in  constant,  but  in 
periodic  effects.  If  the  reader  is  interested  in  this 
case,  I  will  mention  one  or  two  other  incidents  in  it. 
After  quinine  had  failed  to  improve  the  patient  at 
all,  and  when,  notwithstanding  the  administration 
of  arsenic,  the  attacks  still  recurred,  much  benefit 
was  obtained  by  an  early  morning  shower-bath, 
given  in  the  primitive  way  of  emptying  a  large 
calabash  full  of  water,  left  in  the  open  air  all  night, 
over  the  head  and  shoulders  and  back  of  the 
patient.  It  was  guilelessly  believed  that  the  water 
was  more  efficacious  for  having  been  left  out 
all  night ;  but  obviously  it  was  the  cold  shower 
bath  which  did  the  good,  and  a  bath  fitted  up  in 
the  house,  if  there  had  been  a  bath-room  in  the 
house,  would  have  had  the  same  or  more  effect. 
By  and  bye,  however,  this  also  lost  its  effect,  and 
the  malarial  attacks  returned,  no  noticeable  and 
permanent  improvement  being  apparent  until  the 
patient  left  the  tropical  country  for  a  temperate 
one.  Even  then,  however,  and  for  30  years 
afterwards,  an  attack  of  ague  came  on  again  with 
every  cold.  The  only  question  remaining  on  one's 
mind  now  in  respect  of  this  case  is  the  following  : — 


109 

Would,  it  may  be  asked,  a  change  of  diet  in  the 
tropical  country  itself,  given  moderately  sanitary 
conditions  present,  would  such  a  change  of  diet, 
say  two  meals  a  day,  to  an  extent  of  not  more  than 
12  ozs.  a  day,  without  a  change  of  climate,  have 
cured  the  patient  ?  For  my  part,  I  believe  it 
would.  Opinions  will  differ  about  this.  It  is  a 
hypothetical  question  which  can  never  be  translated 
into  terms  of  actual  experiment  for  the  given  case, 
although  there  are  no  doubt  now  many  thousands  of 
similar  cases  going  on  among  Europeans  living  in 
tropical  countries,  to  whom  such  a  narrative  may  be 
of  the  very  greatest  interest.  If  my  opinion  is 
sound,  they  might  save  themselves  much  suffering, 
much  trouble,  and  much  money.  The  development 
of  rheumatism,  bronchitis,  and  asthma,  in  the 
temperate  climate,  shewed  how  superficial  was  the 
change  that  relieved  the  patient  (though  it  did  not 
cure  him)  of  the  recurring  malarial  attacks,  and 
shews  also,  to  all  who  wish  to  see  it,  that  the  chief 
cause  of  all  the  ailments,  tropical  and  temperate,  was 
improper  feeding.  I,  at  least,  have  no  doubt  that 
this  man  ate  his  diseases,  that  he  ate  his  malaria, 
his  rheumatism,  his  bronchitis,  and  his  asthma,  of 
all  of  which,  even  after  50  years  of  age  (that  is  the 
surprising  thing)  he  was  able  to  get  rid  on 
changing  his  diet.  No  doubt  he  was  bitten  by 
mosquitoes,  but  the  question  is,  would  their  bites 
have  done  him  much  harm  if  he  had  been  properly 
fed  ?  And  at  any  rate  they  did  not  bite  him  for 
the  30  years  after  he  left  the  tropics,   and  yet  he 


110 

continued  to  have  malaria  for  that  length  of  time, 
and  I  do  not  doubt  would  have  gone  on  having  it 
still  (if  he  had  lived)  if  he  had  not  altered  his  diet. 
Neither  have  I  the  slightest  doubt  that  the  other 
patient  got  rid  of  his  broncho-pneumonias  and  his 
influenzas  by  the  same  means. 

In  the  usual  case,  when  one  of  the  continued 
fevers  is  taken,  scarlet  fever,  for  instance,  which 
does  not  as  a  rule  occur  more  than  once  in  life,  it  is 
difficult,  as  I  have  said,  to  see  the  effects  of  the 
continuance  of  long  acting  causes,  like  prolonged 
improper  feeding.  What  usually  happens  is,  either 
that  some  inflammation,  or  an  attack  of  some  other 
fever,  follows  as  the  effect  of  long  acting  or  of  the 
frequently  repeated  causes.  The  person  who  has 
had  scarlet  fever  before  does  not,  as  a  rule,  take 
scarlet  fever  again  (he  does  so  sometimes,  however), 
but  he  has,  say,  an  attack  of  diphtheria,  or  of 
measles,  perhaps,  or  typhoid  fever,  or  perhaps  a 
severe  "  feverish  cold  " ;  and  so  the  causal  nexus  is 
not  seen.  As  the  disease  is  called  by  a  difierent 
name  in  each  case,  and  as,  further,  it  is  attributed 
to  such  exciting  causes  as  infection,  exposure  to 
cold,  damp,  fatigue,  &c.,  the  connection  of  each 
attack  with  the  predisposing  cause  of  improper 
feeding,  and  with  the  bad,  unresisting  state  of  body 
so  induced,  is  not  seen,  or  is  overlooked.  Yet  all 
the  while,  the  occurrence  of  the  severe  feverish  cold, 
or  of  the  measles,  or  of  the  broncho-pneumonia, 
was,  or  might  have  been,  as  much  the  efiect  of 
long-continued    improper    feeding,    as   the   original 


Ill 

attack  of   scarlatina,   or   other  so-called   infectious 
fever  was. 

As  was  said  in  the  last  chapter,  it  is  commonly 

beHeved  that  the  fevers  are  caused,  not  by  improper 

feeding,  but  by  breathing  bad  or  vitiated  air ;   and 

on  this  doctrine  the  whole  of  the  modern  practice 

regarding  the  prevention  of  the  fevers   has   been 

based.     Having   suggested   before   that  I  was  not 

altogether  satisfied  with  the  truth  of  this  doctrine, 

I  now  proceed  to  give  some  more   of    the   reasons 

which    lead   me    to    disbelieve    in   its  correctness. 

Attention  to  air  and  to  supplying  an  abundance  of 

pure   air  is  an  excellent  measure,  and  has  had   a 

great  influence  in  preventing  the  incidence  of  fevers, 

as  it   has   had   also   in  limiting  their   spread.     In 

point  of  fact,  it  has  diminished  fevers  by  from  40  to 

50  per  cent,  in  the  last  forty  or  fifty  years.     But  if 

bad   air  had  been  the  whole  of  the  cause,   or   the 

main   part  of  the  cause,  of  fevers,  supplying  good 

air  would  probably  have  diminished  fevers  by  more 

than  40  or  50  per  cent.     When,  for  instance,  the 

chief  cause  of  bronchitis  is  known  and  is  eliminated 

(except,    of   course,  in  those   cases   where   organic 

change  has  gone  so  far  as  to  have  rendered  recovery 

impossible),  not  only  is  the  bronchitis  cured,    but 

its  recurrence  is  prevented.     If  we  had  been  acting 

on  the   whole  of  the  cause  of  fevers  we  ought   to 

have   diminished   them    by    80    or    90    per    cent. 

Besides   this,    under    a   free   supply   of    good   air, 

influenza  (which  is  a  fever,  for  the  micro-organism 

associated  with  it  is  known  and  cultivated)  has  come 


112 

among  the  English  people,  and  has  annually  attacked 
them  since  1890  or  so.  It  is  plain,  therefore,  that 
bad  air  is  not  the  main  cause  of  influenza,  although 
it  may  be  a  contributory  cause,  and  that  of  an 
important  character.  Another  reason  for  thinking 
that  bad  air  has  had  too  much  importance  attached 
to  it  as  a  cause  of  fevers  is  that  during  the  past  ten 
years  no  appreciable  diminution  in  the  incidence  or 
mortality  from  fevers  has  been  effected  in  England 
and  Wales.  This  statement  may  appear  ex- 
travagant to  those  who  have  had  in  their  minds 
only  the  great  reduction  which  has  taken  place  in 
the  incidence  and  mortality  from  the  infectious 
fevers  or  the  zymotic  diseases  during  the  last  two 
generations.  The  following  facts,  therefore,  on 
which  this  statement  is  made,  will  be  of  interest. 
In  the  five  years,  1876-80,  the  death  rate  from 
zymotic  disease  in  England  and  Wales  was  3*823 
per  1000;  in  1881-5  it  was  2*804  per  1000;  in 
1886-90  it  was  2*502  per  1000  ;  in  1891-5  it  was 
2*747  per  1000  ;  and  in  1896-99  it  was  2*678  per 
1000.  It  will  be  seen  that  the  zymotic  mortality 
was  less  in  1886-90,  before  influenza  appeared,  than 
it  was  in  1891-5  or  1896-99.  About  the  time  of 
the  Crimean  War,  the  death  rate  from  the  zymotic 
diseases  was  about  5*240  per  1000  per  annum. 
Since  that  time  the  fall  has  been  very  marked ; 
but  in  the  last  ten  years  there  has  been  a  slight 
increase  instead  of  a  diminution.  It  seems  as  if  we 
had  exhausted  the  benefit  in  this  respect  which  we 
are  likely  to  get  from  improved  sanitation,  so  far, 


113 

that  is,  as  improved  air  is  concerned.  In  1890 
influenza  caused  4523  deaths  in  England  and 
Wales;  in  1891,  16,686;  and  in  1895,  12,880 
deaths.  In  1896-7-8-9  and  1900  the  numbers  were 
3753,  6088,  10,405,  12,417,  and  16,245,  respectively. 
In  attempting,  therefore,  to  come  to  a  con- 
clusion regarding  the  causes  of  the  fevers  or 
zymotic  diseases,  these  three  reasons  make  us 
hesitate  to  accept  the  prevailing  opinion  that 
breathing  bad  or  vitiated  air  is  the  most  important. 
(1)  The  reduction  of  fever  has  only  been  from 
about  40  to  50  per  cent,  in  about  50  years  ;  (2) 
during  the  last  ten  years  there  has  been  no 
reduction  in  the  mortality  from  fevers  at  all  ;  and 
(3)  during  the  last  ten  years  influenza  has  come, 
apparently  to  stay.  No  intermission  has  taken 
place  in  our  sanitary  efforts  during  that  period. 
On  the  contrary,  our  sanitary  authorities  are 
carrying  out,  with  the  loyal  co-operation  of  the 
people,  and  even,  it  may  be  said,  under  instruc- 
tions from  them,  vast  sanitary  works,  whose 
total  cost  must  be  little,  if  at  all,  short  of  the 
amount  of  the  National  Debt  of  this  country. 
The  results  are  not  satisfactory — certainly  not  so 
satisfactory  as  they  ought  to  be ;  and  my  suggestion 
is,  Has  not  a  main  part  of  the  cause  of  these 
epidemic  diseases  been  overlooked  ?  I  suggest  that 
this  is  so,  and  that  what  has  been  overlooked  is  the 
increased  frequency  of  meals,  which  is  so  character- 
istic of  our  time.  The  three  meals  a  day  which 
used  to  be  sufficient  for  us  are  no  longer  so.     Even 

H 


114 

our  paupers,  breakfasting  at  8-0  or  8-30,  have  a 
lunch  of  bread  and  cheese,  men  and  women  aUke,  at 
10-30  or  11  a.m.,  and  dine  at  12-30.  It  is  quite 
impossible  that  the  food  taken  at  8-0  a.m.  can  be 
digested  at  10-30  or  11-0;  and  it  is  equally 
impossible  that  that  taken  at  10-30  can  be  digested 
at  12-30  or  1-0  p.m.  There  is  no  time  for  it.  Even 
when  breakfast  is  taken  at  8-0,  digestion  is  so  slow 
in  many  cases  that  the  food  is  not  digested — 
frequently  it  has  not  left  the  stomach — at  12-30 
or  1-0.  But  even  if  this  is  not  very  frequently  the 
case,  and  if,  therefore,  it  is  reasonable  to  take  a 
second  meal  four  or  four-and-a-half  hours  after  the 
first,  it  is  quite  certain  that  food  taken  at  10-30  is 
not  digested  at  12-30  or  1-0.  There  is  no  time  for 
it  to  be  so.  Nothing,  therefore,  could  be  less  wise, 
physiologically,  than  the  interpolation  of  this  super- 
numerary meal,  and  the  interpolation  is  a  very 
striking  instance  of  carrying  out  into  practice  the 
unsound  doctrines  which  are  current  on  this  subject 
at  the  present  time.  One  wonders  where  the 
physiological  advisers  of  the  Local  Government 
Board  were,  or  what  they  were  thinking  about, 
when  this  course  was  adopted  at  the  public  expense. 
The  same  course  in  principle  has  been  followed  in 
arranging  the  diet  of  our  sailors  in  the  Navy, 
although  there  is  no  proof  that  they  were  under-fed 
or  too  seldom  fed  before.  One  must  only  hope  that 
their  fighting  powers  will  not  be  impaired  by  the 
new  regime,  and  that  there  will  be  no  more  sickness 
among  them  than  before.     The  experience  of  the 


115 

Boer  War  in  South  Africa  was  to  the  effect  that  our 
men,  after   having  a  cup  of  coffee  and   a   biscuit 
about  four  in  the  morning,  marched  or  rode  there- 
after till  about  four  in  the  afternoon,  when  they 
halted  and  had  a  meal,  that  completing  the  tale  of 
their  food  for  24  hours,  and  that  on  this  diet  they 
were  active  and  well.     These  men  were  in  the  early 
flush   of    life   and    activity,    and   were   also    doing 
active  work.     If  they  could  thrive  on  these  food 
arrangements,    how   unnecessary   must   it    be    con- 
sidered to  allow  more  numerous  meals  to  paupers 
leading  for  the  most  part  an  inactive  or  little  active 
life.     It  is  no  reproach  to  the  paupers  that  they 
should  be  inactive  at  the  age  which  many  of  them 
have  reached,  but  still  it  must  be  remembered  that 
in  inactivity  less  food  is  required  than  when  persons 
are   younger   and    performing   more   active   duties. 
The  experience  of  the  Boman  soldiers,  who  were 
called  upon  to  do  anything  and  to  go  anywhere,  was 
very  similar  to  that  of  our  men  in  South  Africa,  for 
de  Quincey  tells  us  that  they  ate  once  a  day.     The 
habit  of  taking  food  once  a  day  must  have  been  a 
recognised   one  among   some  of  the  population  of 
imperial  Home,  for  we  find  Celsus  recommending,  in 
the  second  century  of  the  Christian  era,  the  taking 
of  two  meals  rather  than  one.     '^  Bis  die  potius/' 
he   says,   "  quam   seniel  cihum   caper e."     Still   we 
should    hardly    be    justified    in    inferring    that    it 
was  anything  like  a  universal  custom  in  imperial 
Rome  to  eat  once  a  day,  or  even  twice,  for  we  find 
from  Athenaeus,  perhaps  50-100  years  after  the  time 

H2 


116 

of  Celsus,  that  the  custom  had  quietly  altered,  aud 
that  it  had  become  usual  to  take,  as  we  are  doing 
now,  four  or  five  meals  a  day.  These  were  named 
oLKpaTia-fia  (early  breakfast),  apicrrov  (perhaps  similar 
to  what  we  call  lunch,  although  the  term  is  often 
applied  to  breakfast),  icnrepLa-fxa  (an  afternoon 
meal),  and  SeuTrvov  (supper).  Under  the  influence 
of  the  spread  of  wealth,  just  as  is  happening  in 
this  country  now  (it  is  not,  it  seems  to  me,  the 
poverty  of  England,  it  is  its  wealth  which  is  our 
danger — it  is,  I  mean,  the  foolish  use  we  are  making 
of  our  wealth  and  its  bad  distribution),  food  customs 
gradually  altered  in  the  ancient  world.  The  time 
had  long  gone  by,  and,  more  important  still,  the 
human  outlook  had  greatly  altered  since  the  time 
when,  about  500  years  before  Christ,  Hippocrates 
describes  the  practice  of  what  was  then  the  Ancient 
Medicine,  and  in  reference  to  which  he  gives  his 
own  personal  opinion  that  it  is  immaterial  whether 
a  man  eats  once  a  day  or  twice.  We  seem  to  have 
it  suggested  to  us  that  at  that  time  it  was  a 
common  custom  to  do  either  one  or  the  other.  In 
other  places  in  his  writings,  it  is  true,  Hippocrates 
refers  to  customs  involving  the  taking  of  more 
frequent  meals,  so  that  there  was  evidently  no  fixed 
rule  among  the  Greek  peoples  among  whom  he 
practised.  It  is,  however,  interesting  to  note  that 
those  among  ourselves  who  have  been  so  profoundly 
shocked  by  the  suggestion  recently  resuscitated 
among  us,  that  it  is  often  wise  to  abstain  from  the 
meal  called  breakfast  (or  rather  postpone  it,  for  that 


117 

is  the  meaning  of  taking  the  first  meal  at  12  or  one 
o'clock — it  is  a  postponement,  not  an  omission  of 
the  breaking-of-the-fast),  might,  if  they  chose  to 
think  or  to  read  a  little,  find  that  many  thousands 
of  the  inhabitants  of  this  planet  have  lived  long 
and  happily  and  usefully  on  even  one  meal  a  day, 
as  well  as  on  two.  A  piece  of  advice  offered  by 
Hippocrates  to  his  countrymen,  some  time  before 
they  successfully  opposed  the  Persian  invasion  of 
Greece  by  Xerxes,  was  to  the  effect  that,  if  a  man 
found  himself  not  very  well,  he  should  abstain  from 
breakfast,  at  least  if  the  weather  was  hot.  At  this 
season,  the  physiological  instinct  of  the  physician 
told  him  from  his  clinical  experience,  although  he 
had  no  chemical  ideas  to  guide  him,  chemistry  up 
to  that  time  being  only  an  alchemist's  dream,  that 
a  man  required  less  food  then  than  he  did  in  cold 
weather.  Let  the  man,  says  Hippocrates,  go 
without  his  breakfast  (dvaptaTos  fikv  Stayero)),  if  it 
is  summer  time. 

It  is  no  part  of  the  physician's  duty  to 
trench  on  the  sphere  of  the  moralist  or  spiritual 
adviser;  but  if  a  proper  view  of  the  processes 
of  nature  is  taken  by  each  in  his  own  sphere, 
it  is  remarkable  how  similar  is  its  course  seen 
to  be  in  all  departments ;  and  it  is  impossible 
to  avoid  being  struck  by  the  observation  that,  as 
great  and  numerous  banquets  and  other  forms  of 
sensuous  indulgence  have  become  prominent,  so 
have  the  nations  pursuing  that  course  of  conduct 
decayed.     What  has  happened  before  will  certainly 


118 

occur  again ;  and  any  nation  which  pursues 
pleasure,  wealth,  and  sensual  gratification  too 
keenly,  will  certainly  begin  to  decay  and  perish. 
In  this  respect,  as  in  every  other,  moderation  is  the 
only  fixed  and  the  only  unfailing  rule.  If  the 
Roman  habit  came  to  be  to  take  jeiitaculum, 
prandium,  and  coenam,  breakfast,  dinner,  and  supper, 
as  we  now  call  them,  we  know  that  at  former  times, 
as  Celsus  hints  to  us,  the  Komans  lived  on  fewer 
meals  than  three  ;  and,  unfortunately,  we  also  know 
that,  as  wealth  increased  among  them,  so  did 
luxury,  and  that  luxury  translated  itself  among 
them  as  one  of  its  forms  into  the  taking  of  more 
and  more  meals,  of  a  more  and  more  elaborate  sort, 
and  that  the  habits  accompanying  this  mode  of 
living  coincided  in  the  most  marked  manner  with 
national  decay.  It  has  often  seemed  as  if  a  very 
striking  parallel  might  be  drawn  between  the 
Rome  of,  say,  200  to  350  A.D.,  and  the  London  of 
to-day.  "  Rome,"  says  Athenaeus,  writing  prob- 
ably about  250  A.D.,  "may  fairly  be  called  the 
nation  of  the  world.  And  he  will  not  be  far  out 
who  pronounces  the  city  of  the  Romans  an 
epitome  of  the  whole  earth ;  for  in  it  you  may  see 
every  other  city  arranged  collectively,  and  many 
also  separately;  for  instance,  there  you  may  see 
the  golden  city  of  the  Alexandrians,  the  beautiful 
metropolis  of  Antioch,  the  surpassing  beauty  of 
Nicomadia,  and  besides  all  these,  that  most 
glorious  of  all  the  cities  which  Jupiter  has  ever 
displayed,    I   mean   Athens.       And    not    only    one 


119 

day,  but  all  the  days  in  an  entire  year,  would  be 
too  short  for  a  man  who  should  attempt  to 
enumerate  all  the  cities  which  might  be  enumerated 
as  discernible  in  that  uranopolis  of  the  Bomans, 
the  city  of  Rome,  so  numerous  are  they.  For, 
indeed,  some  entire  nations  are  settled  there, 
as  the  Cappadocians,  the  Scythians,  the  people  of 
Pontus,  and  many  others."  How  can  one  fail  to 
be  struck  by  the  similarity  between  the  state  of 
things  here  described  as  obtaining  in  Bome  at  that 
time,  and  that  obtaining  in  London  to-day  ? 
Substitute  modern  cities  arranged  collectively  and 
separately  for  the  ancient  ones  named  by 
Athenaeus ;  substitute  the  thousands  of  Frenchmen 
in  London  from  gay  and  volatile  Paris,  the 
thousands  of  Italians  from  ancient  and  stately 
Bome,  the  thousands  of  Germans,  harsh  of  speech 
and  full  of  enterprise,  from  our  neighbouring 
Teutonic  land,  and  we  have  a  picture  of  the 
uranopolis  of  London  very  like  the  uranopolis  of 
ancient  Bome.  And  if  we  add  to  the  picture  the 
Jews  in  England,  probably  not  less  numerous  than 
the  whole  of  the  race  resident  in  Palestine  in  her 
most  palmy  days,  and  picture,  besides,  the 
representatives  of  Australia,  Canada,  and  New 
Zealand,  the  refined  and  subtle  Indian,  and  the 
patient  and  artistic  Chinese,  not  to  speak  of 
representatives  of  the  still  uncivilised  South  African 
peoples,  our  imagination  must  be  poor  and 
unmovable  indeed  if  we  do  not  see  a  likeness 
between  ancient  Bome  and  the  modern  commercial 


120 

capital  of  the  world.  And  if,  in  spite  of  ourselves, 
we  proceed  to  inquire  whether  the  causes  that 
subverted  the  one  are  not  again  in  action,  tending 
to  dethrone  the  other,  and  if  we  feel  ourselves 
compelled  to  reflect  that  even  in  despite  of 
Christianity,  the  absence  of  slavery,  at  least  in 
name,  and  the  existence  of  free  political  institutions  ; 
the  spread  of  luxury  and  the  unrestrained  worship 
of  wealth  and  pleasure  are  becoming  very  apparent 
in  the  London  of  to-day,  we  are  compelled  to  pause 
and  consider.  There  is  no  doubt  plenty  of  grit  in 
England  yet — there  are  more  than  seven  thousand 
men  who  have  not  bowed  the  knee  to  Baal  in  this 
matter — but  the  general  tendency  towards  ex- 
travagance and  luxury,  who  can  fail  to  be  struck  by 
it,  or  who  can  refrain  from  asking  to  what  it  may 
lead  ?  Panem  et  Circenses,  said  the  Roman 
proletariat ;  food  and  amusement  for  nothing.  Are 
not  these  parallelled,  if  faintly,  by  heavy  receipts 
of  gate  money  at  sports,  by  demands  for  houses 
without  payment  or  equivalent  contributions  in 
labour,  by  demands  for  old  age  pensions  towards 
which  no  contributions  are  to  be  made  by  the 
recipients,  the  while  that  charities  are  languishing 
for  lack  of  support,  while  art  and  literature  are 
being  neglected,  and  education  can  be  recommended 
and  defended  only  for  the  commercial  advantages 
which  it  is  expected  to  bring  ? 

The  reader  may  here  say  to  himself:  well,  but 
are  not  visitations  of  epidemic  disease  also  well 
known  sometimes  to  be  due,   not   to   over-feeding. 


121 

but  to  under-feeding?  Not  to  plethora,  but  to 
starvation  ?  Was  not  the  relapsing  fever  epidemic 
in  Ireland,  in  1848,  and  the  typhus  fever  that 
accompanied  it,  as  also  the  Indian  recent  epidemic 
of  plague,  due  to  the  failure  of  the  potato  crop  in 
Ireland,  and  to  the  failure  of  the  rice  crop  in  India  ? 
Yes,  I  admit  that  they  were,  but  I  think  that  one 
or  two  qualifications  ought  to  be  made,  which  I 
will  proceed  to  do  directly.  First  of  all,  however, 
let  us  note  this.  I  say  that  moderation  is  the  only 
fixed  and  the  only  unfailing  rule  of  living ;  and  in 
the  case  of  food  supply  to  people  living  in  towns,  I 
attempt  to  more  or  less  define  moderation  (an 
indefinable  and  indefinite  thing,  of  course),  as 
lying  between  12  and  24  ozs.  of  ordinary  diet  of 
wholesome  quality  a  day,  taken  preferably  at  two 
meals,  eight  hours  or  so  apart  from  one  another. 
I  do  not  consider  starvation  as  moderation. 
Starvation  is  as  much  below  moderation  as  plethora 
and  too  frequent  eating  is  above  it.  Neither  is 
good.  Neither,  secondly,  do  I  say  that  starvation 
cannot  cause  fever.  I  think  it  can,  especially  if 
people  have  been  too  well  fed  before.  This  is  the 
first  qualification  which  I  think  ought  to  be  made 
when  I  admit  that  starvation  also  may  cause  fever. 
Because,  if  people  were  in  a  quite  healthy  state 
before,  that  is,  if  they  had  been  moderately  fed, 
neither  by  too  much  nor  by  too  little,  I  believe 
that  the  efiects  of  starvation  would  be  not  to  cause 
fever,  nor  the  feverish  state,  but  to  slowly  wear 
them  down  with  a  slowly  progressive  diminution  of 


122 

strength.  Fever  and  feverishness  are,  I  believe, 
re-actions  from  this  condition,  and  are  due,  not  so 
much  to  the  starvation,  as  to  the  fact  that  for  a 
long  time  previously  their  bodies  and  blood  had 
been  loaded  with  waste  unassimilated  materials 
derived  from  an  excess  of  (even  wholesome)  food. 
The  fever  and  feverishness  are  occasioned  no 
doubt  by  the  fasting,  but  not  caused  by  it.  This 
means,  of  course,  when  we  come  to  analyse  it,  as 
has  been  before  said,  that  the  starvation  is  part  of 
the  cause  of  the  fever,  but  that  the  chief  part  of 
the  cause  is  the  state  that  our  bodies  are  in  when 
the  fast  is  compulsorily  forced  on  us.  So  that  I 
have  come  to  accept  the  conclusion  (I  do  so  for 
myself,  at  least,  which,  if  it  does  not  prove  my 
wisdom,  proves,  at  least,  my  good  faith),  that  if  we 
cannot  fast  without  fever,  it  is  because  we  have 
been  previously  improperly  fed ;  and  in  my  own 
case  I  should  accept  the  verdict,  unquestioningly, 
that  it  was  because  for  some  considerable  time 
previously  I  had  been  over -fed.  But  although 
admitting  in  this  qualified  sense  that  starvation 
may  cause  a  visitation  even  of  epidemic  disease, 
this  admission  does  not  hinder  me  from  asserting 
that,  as  a  rule,  epidemics  are  in  fact  caused  far 
more  frequently  by  over-feeding  than  by  starvation. 
There  is,  however,  another  and  a  more 
important  qualification  which  I  would  make 
regarding  the  admission  that  starvation  may  cause 
epidemic  disease,  and  that  is  this.  It  seems  to  me 
to   have  been  too  much    overlooked.     When  crops 


123 

fail,  so  as  to  cause  famine,  they  seldom  fail  utterly, 
but  they  are  short  and  had.  The  potato  in  Ireland, 
and  the  rice  in  India,  were  not  only  short,  but  they 
were  also  diseased.  I  think  that  shortage  and 
badness  of  crops  may  well  be  admitted  to  account 
for  the  presence  of  epidemic  disease  among  a  people 
said  or  thought  to  be  suffering  from  starvation  pure 
and  simple,  when  mere  shortage  might  not  have 
been  sufficient  to  account  for  it. 

These  are  in  brief  the  reasons,  or  some  of  them, 
why  I  cannot  accept  or  feel  satisfied  with  the 
prevaihng  opinion  that  bad  air  is  the  chief  cause  of 
the  fevers.  I  might  corroborate  this  opinion  by 
other  well  known  facts.  When  a  person  who  is 
taking  too  much  alcohol  makes  up  his  mind  to  pull 
up  and  cease  taking  it,  he  frequently  suffers  very 
much  at  first,  and  for  several  weeks,  after  getting 
on  to  a  better  way  of  living.  He  institutes  a  fast 
from  alcohol,  and  it  distresses  him  greatly. 
Obviously,  his  distress  is  occasioned  by  his 
abstinence  from  alcohol,  that  is,  his  abstinence  is 
a  part  of  the  cause  of  his  distress,  but  the  chief 
part  of  the  cause  is  not  the  abstinence,  but  the  fact 
that  for  a  long  time  previously  he  was  in  the  habit 
of  taking  too  much.  And  if,  on  account  of  his 
distress,  which  is  no  doubt  real  enough,  and  not  at 
all  imaginary,  he  should  throw  up  his  good 
resolutions,  and  say  that  total  abstinence  did  not 
suit  him,  he  would  not  only  be  very  unwise,  and 
very  unreasonable,  but  he  would  in  addition  be  in 
the  perilous  way  of  running  the  risk  of    forfeiting 


124 

whatever  chance  he  might  have  had  of  recovering 
his  health,  and  of  overcoming  his  bad  habits.  And 
so  with  the  person  who  finds  himself  sufiering  from 
a  fever,  due,  as  he  may  suppose,  to  too  little  food. 
It  is  not  the  fast,  but  the  previous  over-feeding, 
from  which  he  is  really  suffering,  and  which  is  the 
most  potent  cause  of  his  attack.  The  reference  to 
alcohol  may  perhaps  justify  my  going  on  to  say 
that  while  alcohol,  in  those  who  take  too  much  of  it, 
may  be  a  cause,  and  a  potent  one,  of  epidemic 
disease,  it  seldom  accounts  for  the  onset  of  the 
Fevers  in  this  country.  These  affections,  measles, 
scarlatina,  diphtheria,  chicken  pox,  &c,,  are  mainly 
rife  among  children,  who,  as  a  rule,  take  no  alcohol 
at  all.  No  doubt,  however,  epidemics,  like 
influenza,  typhus,  small  pox,  &c.,  which  are  apt  to 
attack  older  people,  may  to  some  extent  be  caused 
by  the  excess  of  alcohol  in  which  too  many  of  our 
grown  people  indulge.  And  perhaps  I  may  be 
pardoned  if  I  add  that  persons  who  are  advised  to 
restrict  their  diet  in  order  that  they  may  get  rid  of 
ailments  from  which  they  may  have  long  suffered, 
either  mild  and  long  -  continued  ailments,  or 
recurring  attacks  of  a  more  severe  or  acute 
character,  not  infrequently  suffer  severely  at  first, 
and  even  for  a  long  time  after  commencing  a  better 
way  of  living.  Their  bodies  at  once  begin  to 
eliminate  the  unassimilated  stuff  that  is  in  them,  a 
process  which  is  as  trying  in  its  way,  and  brought 
about  quite  in  the  same  way  as  the  distress  of  the 
alcoholic    who   becomes    a    total   abstainer.        The 


125 

over-eater  who  adopts  restriction  (a  class  to  which 
I  fear  most  of  us  belong,  though  we  do  not  hke  to 
admit  it),  finds  himself  greatly  distressed  by  his 
new  mode  of  life  ;  but  how  very  unwise  it  is  of  him 
or  her,  if,  as  so  many  unfortunately  do,  he  makes  up 
his  mind  that  this  plan  will  not  suit  him,  and  if, 
because,  for  example,  he  does  not  sleep  for  a  night 
or  two,  or  otherwise  feels  a  disagreeable  aching 
void,  he  throws  the  whole  thing  up,  and  returns  to 
his  three-hourly  meals,  and  to  heavy  and  late 
suppers.  We  see  the  folly  of  this  clearly  enough  in 
the  case  of  the  alcoholic,  but  the  folly  of  the  other 
person,  though  quite  as  great,  does  not,  un- 
fortunately, strike  us  so  strongly. 


126 


CHAPTER    V. 


Some  observations  on  the  Circulation  of  the 
Blood  and  of  the  Lymph,  as  bearing 
particularly  on  the  question  of  Food  Supply 
to  the  body. 


TT7HE  circulation  of  the  blood,  although  so  much 
has  been  heard  of  it  since  it  was  discovered  by 
Harvey,  the  physician  to  King  Charles  the  First 
(1578-1657),  does  not  appear  to  me  to  have  received 
the  amount  of  attention,  or,  perhaps  I  should  rather 
say,  the  sort  of  attention  which  it  deserves.  One's 
first  impulse,  no  doubt,  is  to  say,  offhand,  that  it 
has  revolutionised  the  practice  of  medicine  and 
surgery  ;  but  I  do  not  know  that  this  statement 
can  be  truthfully  made.  Some  mechanical  improve- 
ments have  no  doubt  been  introduced  into  surgery, 
as,  eg. J  the  tying  of  arteries  in  various  places  to 
cure  diseases  in  the  course  of  these  vessels,  or  the 
removal  or  obliteration  of  veins  for  diseases  of  their 
coats,  since  the  general  course  of  the  circulation  of 
the  blood  has  become  known  ;  but  the  general 
practice  of  medicine  has  scarcely  been  altered  at 
all,  and  any  changes  in  it  which  have  been 
effected  have  been  introduced  through  considerations 
independent  of  our  views  upon  the   circulation  of 


127 

the  blood  and  lymph.  It  may  help  us  to  realise 
this  better  if  we  reflect  that  hundreds  of  years 
before  the  circulation  of  the  blood  and  lymph 
became  recognised  as  an  established  fact  (yes, 
hundreds  of  years  before  —  I  had  almost  said 
thousands  of  years  before — 1400  years,  at  least), 
physicians  were  in  the  habit  of  feeling  the  pulse 
when  they  visited  their  patients.  They  thought, 
no  doubt,  that  they  were  feeling  the  vein  and  not 
the  artery,  which  last  they  believed  to  contain  air 
and  not  blood  (although  in  one  passage  Galen,  who 
died  A.D.  200,  seems  to  say  that  the  artery  con- 
tained blood  and  not  air).  The  very  name  artery 
means  air-container  {^aer  =  air),  and  the  ancients 
believed,  so  far  as  their  somewhat  vague  notions  can 
be  made  out,  that  the  arteries  were  somehow  the 
finer  divisions  of  the  wind-pipe,  which  they  knew 
to  contain  air,  and  which  they  called  arteria 
aspera,  or  the  rough,  hard  air-container,  so  contra- 
distinguishing it  from  the  ordinary  or  softer  vessels, 
which  they,  named  veins.  This  was  an  easy  mistake 
to  make,  or,  at  least,  not  so  unlikely  as  we  might 
have  supposed,  because,  if  we  trace  the  wind-pipe 
into  the  lungs,  we  find  it  breaking  up  into  branches 
which  we  now  call  bronchi^  and  these  again  into 
finer  and  finer  ones,  which  we  call  bronchia  ;  and 
we  also  find  the  same  division  and  breaking  up 
characterise  the  behaviour  of  the  pulmonary  artery 
as  it  finds  its  way  into  the  lung-tissue,  the  finest 
branches  of  it  accompanying  and  being  somewhat 
easily    mistaken    for    the    finest    divisions   of    the 


128 

trachea,  bronchi,  and  bronchia.  But  although  the 
ancient  physicians  of  Greece  and  Kome  could  not  be 
said  to  know  much  about  the  circulation  of  the 
blood,  that  ignorance  cannot  be  said  to  have 
mihtated  much  against  their  success  as  practitioners 
in  the  treatment  of  the  sick.  If  we  were  to  ask, 
indeed,  in  what  respects  they  were  worse  practi- 
tioners than  we  are  to-day,  it  would  be  difl&cult  to 
reply  satisfactorily.  They  had,  or,  at  least,  the 
best  of  them  had,  a  general  grasp  of  their  subject, 
of  its  theory,  and  of  the  consequent  art  of  medicine, 
which,  with  all  our  science,  it  were  much  to  be 
wished  many  of  us  possessed  now.  The  best  of 
them  knew,  for  instance,  and  were  greatly  impressed 
by  the  fact,  that  the  body  was  one  organic  whole, 
and  that,  therefore,  its  diseases  were  one  ;  that 
they  were  departures  from  normal  conditions  ;  that, 
therefore,  it  was  more  or  less  accidental  whether 
this,  that  or  the  other  member  or  part  of  the 
body  suffered,  since  its  sufferings  were  almost  always 
local  marks  of  general  disorder,  or,  as  we  might  say 
now  (and  as  in  fact  some  do  say),  most  local  diseases 
are  the  local  expression  of  general  states ;  and  that, 
for  their  successful  treatment,  therefore,  it  is  not 
and  cannot  be  enough  to  confine  our  attention  and 
efforts  to  the  organ  or  part  affected,  but  that  if  any 
real  or  permanent  benefit  is  to  be  achieved,  we  must 
treat  the  organism  as  a  whole.  We  may  note  in 
this  connection  what  Coelius  Aurelianus,  writing  in 
the  earlier  part  of  the  Christian  era,  said,  in 
discussing  what  part  of  the  body  was  at  fault  when 


129 


phrenitis,  as  he  called  it,  was  present.  After  saying 
that  some  said  it  was  the  head,  others  that  it 
was  the  brain,  and  others  that  it  was  the  membranes 
of  the  brain,  he  delivers  himself  of  this  reflection, 
profoundly  philosophical  as  it  seems  to  me,  and 
exemplifying  a  point  of  view  and  a  grasp  too 
seldom  attained  to-day  by  our  too  highly  scientific 
practitioners  :   Nos  igitur  commtmiter  totum  corpus 

pati  accipimus sedplus  pati  dicimus  caput. 

"  I  therefore  am  of  opinion  that  all  the  parts  of  the 
body  suffer  in  common,  but  that  the  head  suffers 
most  of  all."     As  if  he  had  said,  what  is  profoundly 
true  :  ' '  Most  local  ailments  are  only  local  expressions 
of  general  states."     The  specialist  is  by  implication 
here  relegated  to  his  proper  place,  and  is  informed, 
if  he  has  wit  enough  to  read  the  lesson  presented 
to  him,  that  it  is  not  sufficient  to  remove  an  ovarian 
tumour,  e.g.,  and  that  if  nothing  is  said  at  the  same 
time  or  subsequently  as  to  the  causes  which  induced 
it,  a  positive  damage  may  be  done  to  the  woman, 
who  may,  therefore,  while  considering  herself  cured, 
proceed  to  manufacture  one  on  the  other  side,  or 
may   find   herself    in   a   few   years    suffering   from 
cancer  in  the  stump  of  the  previous  one.     Or  the 
child  who  has  tonsils  removed,  and  adenoids  cleared 
away,   may  and   certainly  will  subsequently  suffer 
from  colds,  bronchitis,  broncho-pneumonia,  and  the 
like,  and  by  and  bye  probably  from  rheumatism  or 
rheumatic  fever,   &c.,   unless  at  the  same  time  or 
subsequently  to  the  operation,  his  mother  is  advised 
to  treat  him  differently  from  the  way  in  which  she 


130 

treated  him  before.  For,  if  she  does  not,  a  worse 
thing  may  happen  to  him  in  the  future,  and  so  the 
operation  which  was  intended  to  benefit  may 
eventuate  in  damage  and  not  in  good.  Evidently 
the  same  causes  which  enlarged  the  tonsils  and 
caused  the  adenoid  growths  on  the  soft  palate  and 
nose  will,  if  they  are  allowed  to  go  on,  tend  to 
make  the  child  ill  again  either  in  the  same  or  in 
some  other  way.  Or  the  middle-aged  woman,  who 
has  a  chronic  discharge  from  her  nose,  may  get  it 
stopped,  indeed,  by  having  her  nose  cauterised  by  a 
platinum  wire  made  white  hot  by  the  electric 
current,  only  to  find  herself  in  a  few  months 
suffering  from  cancer  of  the  breast,  which,  being  in 
turn  removed,  eventuates  in  cancer  of  the  liver,  for 
which  there  is  no  relief  These  illustrations  are,  I 
may  say,  by  no  means  imaginary,  but  are  drawn 
from  experience  of  cases  in  practice. 

To  return  now  to  the  question  of  the  cir- 
culation of  the  blood,  and  the  influence  which  its 
discovery  has  had  on  practice,  let  us  listen  to  this 
statement  of  Celsus,  the  great  Latin  physician,  who 
wrote  and  practised  in  the  second  century  of  the 
Christian  era.  In  his  De  medicina  he  makes  the 
following  interesting  observations.  "  On  the  other 
hand,  very  often  the  sun,  a  bath,  exercise,  fear, 
anger,  or  any  other  emotion  of  the  mind, 
accelerates  the  pulsations  {concitat  venas\  so  that 
when  a  physician  first  comes  in,  the  solicitude  of 
the  patient,  doubtful  and  apprehensive  respecting 
what  opinion  the  physician  may  have  of  his  case,  is 


131 

of  itself  sufficient  cause  to  excite  the  pulse.  For 
this  reason  it  is  the  part  of  a  skilful  physician,  not 
to  seize  the  patient's  arm  immediately  as  he  enters 
the  chamber,  but  let  him  sit  down  first,  with  a 
cheerful  countenance,  and  enquire  how  he  finds 
himself,  and  if  he  seems  alarmed,  soothe  him  with 
some  plausible  observations  ;  then  he  may  apply  his 
hand  to  the  body"  (feel  the  pulse).  "But  how 
easily  might  a  thousand  other  incidents  excite  the 
veins "  (heart's  action  and  pulse)  ' '  as  well  as  the 
sight  of  a  physician  !  "  (Celsus  III.,  6). 

This  passage  is  very  interesting,  and   has  long 
been  held  to  be  so.     It  shews  us  how  practically 
useful  a  physician  might  be,   even  although  he  did 
not  know  the  course  of  the  circulation  of  the  blood, 
and  had  no  proper  appreciation  of  its  facts  and  of 
its  meanings  ;  and  it  brings  conspicuously  before  us 
the   fact  that   the  ancient  physician,   hundreds  of 
years    before    the     discovery    of    the     circulation 
of  blood,  still  felt  his   patient's  pulse  in  order   to 
judge    of    the    condition    he   was   in,    and   knew, 
further,    that    the   state   of    the    pulse   might   be 
affected   by   many   things   and   circumstances,    for 
which,  therefore,  due  allowance  had  to  be  made,  if 
he  wished  to  properly  appreciate  his  patient's  state. 
Galen's  views  on  the  pulse  are  also  well  known. 

The  mediaeval  physician,  as  well  as  the  ancient 
one,  also  felt  the  patient's  pulse,  but  on  the  whole 
a  more  metaphysical  attitude  of  mind  characterised 
him  than  that  found  in  his  more  ancient 
predecessor.     The   reader   may  perhaps   pardon    a 

12 


132 

short  digression,  although  I  have  no  wish  to  make 
this  a  historical  essay  on  medicine.  But  by  intro- 
ducing a  few  words  regarding  Dante's  physiological 
ideas,  we  can,  I  think,  perceive  both  the  strength 
and  the  weakness  of  the  mediaeval  mind.  In  the 
Vita  nuova  the  following  interesting  passage  occurs. 
When  at  about  the  end  of  his  ninth  year  Dante  first 
saw  his  Beatrice,  at  about  the  beginning  of  her  ninth 
year,  after  describing  her  dress,  which  was  of  a 
most  noble  colour,  a  subdued  and  goodly  crimson, 
he  goes  on  to  say — and  this  shews  us  by  implication 
and  also  in  fact,  the  physiology  of  the  fourteenth 
century  of  the  Christian  era — "  At  that  moment, 
I  say  most  truly,  that  the  spirit  of  life,  which  hath 
its  dwelling  in  the  secretest  chamber  of  the  heart, 
began  to  tremble  so  violently,  the  least  pulses  of  my 
body  shook  therewith  ;  and  in  trembling  it  said 
these  words  :  Ecce  deus  fortior  me  qui  veniens 
dominahitur  mihi}  At  that  moment  the  animate 
spirit,  which  dwelleth  in  the  lofty  chamber  whither 
all  the  senses  carry  their  perceptions,  was  filled 
with  wonder,  and,  speaking  more  especially  unto 
the  spirits  of  the  eyes,  said  these  words  :  Apparuit 
jam  beatitudo  vestra}  At  that  moment  the 
natural  spirit,  which  dweUeth  there  where  our 
nourishment  is  administered,  began  to  weep,  and, 
in  weeping,  said  these  words  :  Hen  7niser !  quia 
frequenter  impeditus  ero  deinceps.  "^ 

1.  Here  is  a  deity  stronger  than  I ;  who,  coming,  shall  rule  over  me. 

2.  Your  beatitude  hath  now  been  made  manifest  unto  you. 

3.  Woe  is  me  !  for  that  often  I  shall  be  disturbed  from  this  time  forth. 


133 

Now  these  three  spirits,  the  spirit  of  life 
associated  with  the  circulation ;  the  spirit  of  the 
anima,  or  the  animate  spirit,  associated  with  the 
brain  and  nervous  system;  and  the  natural  (or 
regetative  or  animal)  spirit,  associated  with  the 
digestive  system — these  three  spirits  formed  one 
threefold  chain  among  many  threefold  chains  to  be 
found  in  Dante's  poems ;  and  what  perhaps  strikes 
us  most  forcibly  about  them  to-day  is  that  they 
were  metaphysical  or  philosophical  in  character, 
rather  than  scientific,  although  in  this  last 
connection  each  different  spirit  was  associated  with 
a  different  physical  part  and  structure  in  the  body. 
And  we  are  also,  I  think,  struck  by  the  reflection 
that  there  seems  to  be  an  unnecessary  number 
or  multiplication  of  them.  But  let  not  the 
modern  thinker  too  hastily  imagine  that  he  has 
advanced  so  very  far  in  comparison  with  Dante's 
conception;  for  although  to  a  great  extent  he  has 
chosen  to  give  these  mediaeval  notions  the  go-bye, 
or  to  ignore  them,  he  has  not  got  rid  of,  and  he  cannot 
get  rid  of  the  fundamental  conceptions  underlying 
them,  seeing  that  he,  too,  speaks  of  life,  and  vitality, 
and  vital  principle,  and  digestive  power,  and  of 
mind  and  soul.  Without  espousing  any  view,  or 
doing  more  than  indicating  the  one  which  appears 
to  me  to  be  the  most  reasonable  and  the  most 
comprehensive,  I  should  just  like  to  set  down  here 
once  for  all,  and  shortly,  the  three  or  four  lines  of 
thought  which  the  human  mind  tends  to  pursue  in 
dealing  with  structure  and  function.     Plainly  they 


134 

vary  together.  When  structure  is  sound,  function 
is  healthy,  and  when  unsound,  unhealthy.  Hence 
the  view  generally  adopted  by  modern  science  that 
structure  determines  function,  that,  for  example, 
the  structure  of  the  liver  determines  the  secretion 
of  bile.  From  this  to  the  view  that  environment 
determines  organisation,  and  even  that  matter 
determines  mind,  that  the  thing  determines  the 
thought,  there  is  no  long  step.  But,  obviously, 
there  is  no  more  warrant  for  this  view  than  there  is 
for  the  other  one  that  function  determines 
structure,  that  organisation  determines  environment, 
that  mind  determines  matter,  and  that  the  thought 
determines  the  thing.  This  is  the  second  view, 
held  by  some  philosophers,  who  find  themselves  in 
disagreement,  not,  indeed,  with  the  material  results 
of  science,  but  with  her  logic.  Obviously,  as 
function  and  structure  vary  simultaneously,  and 
co-ordinately,  it  does  not  matter,  as  far  as  physical 
results  are  concerned,  which  view  we  adopt.  Then 
there  is  a  third  view,  that  the  thought  is  the  thing. 
And  indeed  there  is  more  to  be  said  for  this  view 
than  perhaps  appears  at  first  sight.  For  if  it  is 
impossible  for  us  to  know  what  a  thing  may  be  in 
itself,  so  to  say,  and  out  of  all  relations  to  other 
things  and  to  other  intelligences,  to  us  our  thought 
of  a  thing  is  the  thing  itself.  What  we  think  it  to 
be,  that  it  is  to  us  for  the  moment.  The  first 
explanation  of  things  is  material ;  the  second  is 
idealistic ;  the  third  is  pantheistic,  or  may  be 
thought   to   lead    to    pantheism.     And   there   is   a 


135 

fourth  possibility  which  is  this  :  that  thought  and 
thing  form  at  each  moment  a  new  combination  and 
a  new  compound  creature,  which  begins  anew  its 
investigation  of  outside  nature,  so  that  we  are 
always  becomitig,  but  never  are.  The  problem  of 
creation  always  has  transcended  and  apparently 
always  will  transcend  the  wit  of  man  ;  and  we  are 
face  to  face  with  it  here  in  the  inquiry  whether 
function  or  structure  was  first.  Who  shall  say 
whether  day  or  night  was  first,  or  hght  or 
darkness  ?  But  it  is  not  nececssary  for  us  to  solve 
the  question,  since  day  always  succeeds  night,  and 
night,  day.  So  structure  and  function  move  and 
change  simultaneously  and  concomitantly.  I  have 
just  said  that  whichever  view  we  adopt,  the  facts 
remain  the  same.  If  we  accept  the  fourth 
explanation  of  organic  phenomena,  or  even  the 
third,  as  the  most  likely  and  reasonable,  I  am  not 
quite  sure  that  this  statement  is  true ;  but  as  the 
question  has  now  become  philosophical  or  theo- 
logical, it  would  be  obviously  improper  to  pursue  it 
further  in  a  disquisition  on  medicine.  Changes  in 
function  and  structm-e,  however,  may,  it  is  evident, 
be  concomitant  or  successive  effects  of  a  common 
cause  (like  the  alternations  of  day  and  night),  as 
well  as  cause  and  effect  of  one  another.  All  I  want 
to  show  is  that  the  questions  raised  by  the 
mediaeval  mind,  as  by  the  ancient  mind,  are  still 
with  us,  and  that  the  calm  assumption  of  modern 
science,  that  structure  determines  function,  that 
matter  determines  mind,  that  the  thing  is  before 


136 

the  thought,  may  be  utterly  denied  by  an  enquirer 
into  the  course  of  nature,  wbo  is  as  humble,  as 
patient  and  painstaking,  as  unbiassed,  as  un- 
prejudiced, as  free  from  the  influence  of  the  personal 
equation  as  it  is  possible  for  mortal  man  to  be. 
These  considerations  will  again  come  before  us 
in  examining  food  supply,  as  they  have  been 
already  raised  by  the  causation  of  fevers, 
and  the  inquiring  reader  may  find  himself 
forced  to  raise  them  also  on  other  occasions.  In 
fact,  whether  soluble  or  not,  these  questions  are 
continually  arising,  both  in  medicine  and  in  life,  and 
seem  to  exercise  a  fascination  on  the  human  mind. 

The  practical  bearing,  however,  of  these  con- 
siderations on  the  circulation  of  the  blood  and 
lymph  is  considerable.  As  the  blood  goes  every- 
where in  the  body,  it  is  obviously  a  matter  more  or 
less  of  accident  which  part  of  the  body  is  afiected. 
If  the  blood  is  sound,  the  parts  of  the  body  will  be 
sound  also,  that  is,  in  the  absence  of  some  more  or 
less  accidental  cause,  which  may  have  for  the 
moment  disturbed  any  given  part.  But  in  this  case 
the  local  irritation  will  soon  be  remedied  by  the 
powers  of  nature,  by  the  circulation  in  the  part  of 
sound  and  healthy  blood,  and  very  soon  all  traces  of 
the  irritation  will  be  gone ;  or  at  least  the  irritation 
will  be  in  proportion  to  the  magnitude  of  the 
exciting  cause,  the  resistance  of  the  part  being 
great  because  of  the  soundness  and  wholesomeness 
of  the  blood,  and  the  suffering,  therefore,  caused  by 
the  irritant  comparatively  slight.     But  let  the  blood 


137 

be  unsound,  loaded,  let  us  say,  with  effete  products 
— it  is  manifest  that  in  this  case  the  effects  of  the 
same  irritant  as  before  may  and  will  be  much 
greater;  and  the  part  affected,  as  also  the  whole 
organism,  will  be  likely,  nay,  certain,  to  suffer  much 
more  than  if  the  blood  had  been  healthy.  This 
would  be  seen  in  the  case  of  a  wound  of  the  arm  or 
leg,  for  instance,  the  suffering  being  proportionate 
to  the  magnitude  of  the  injury  and  inversely  as  the 
healthiness  of  the  blood,  or  proportionately  to  its 
unhealthiness.  If,  now,  a  person  is  exposed  to  a 
draft  or  cold  or  wind  or  damp,  the  same  thing  will 
be  likely  to  happen.  His  weakest  part  will  be 
affected,  his  lung  or  liver  or  stomach  or  eye,  as  it 
may  chance ;  but  the  suffering  will  as  before  be 
proportionate  to  the  magnitude  of  the  exposure  and 
to  the  unhealthiness  of  the  blood  (or  inversely  as 
its  soundness  or  healthiness),  all  of  which  con- 
siderations shew  that  local  affections  or  local 
inflammations  are  far  more  serious  as  being  the 
marks  of  the  general  state  of  the  blood,  than  they 
are  as  being  affections  of  this  or  that  or  the  other 
part.  In  fact,  it  is  an  accident  whether  the  man 
exposed  to  the  exciting  cause,  suffers  in  one 
part  of  his  body  or  in  another,  and  the  same 
general  lines  of  treatment  which  are  proper 
and  suitable  for  the  one  will  be  proper  and 
suitable  for  the  other.  Also,  if  two  organs  are 
affected,  say,  e.g.,  an  internal  organ  and  the  muscles 
of  the  back,  it  is  evidently  much  more  likely  that 
both  the  affections  are  caused  chiefly  by  the  state 


138 

of  the  blood  that  goes  to  both,  than  that  the 
internal  inflammation  causes  the  pain  in  the 
back-muscles,  or  than  that  the  affection  of  the 
back  -  muscles  causes  the  inflammation  of  the 
internal  organ.  The  bearing  of  these  considera- 
tions on  practice,  simple  though  they  are,  is 
considerable.  Sometimes,  too  often  indeed,  we 
are  advised  that  treatment,  say,  of  an  internal 
organ  will  cure  the  muscles  of  the  back,  whereas  it 
would  be  quite  as  rational  to  expect  to  cure  an 
internal  inflammation  by  treating  the  back-muscles 
(driving  needles  into  them,  for  example).  But  by 
treating  the  blood,  by  altering  its  condition,  it  will 
be  rational  to  expect  to  cure  both.  In  fact,  both 
sets  of  effects  are  concomitant  or  successive  effects 
of  a  common  cause,  and  not  cause  and  effect  of  one 
another.  Further,  also,  a  pair  of  "  specialists  "  are 
not  required  for  the  management  of  that  patient. 
He  or  she  is,  in  fact,  better  without  them,  as,  if 
they  were  narrow-minded  specialists,  the  treatment 
of  the  one  would  conflict  with  the  suggestions  of 
the  other  ;  while  if  they  were  broad-minded  and 
judicial,  they  would  both  advise  the  same  general 
line  of  treatment.  The  view,  however,  which  we 
take  of  the  condition  of  the  patient,  and,  conse- 
quently, the  treatment  we  recommend  for  him  is 
precisely  analagous  to  the  third  or  fourth  view 
mentioned  above  respecting  the  relation  of  structure 
to  function,  and  may,  I  hope,  justify  to  the  reader 
my  introduction  of  these  apparently  outside  and 
irrelevant  considerations. 


139 

Besides  feeling  the  pulse,  I  may  also  remind 
the  reader  that,  centuries  before  the  discovery  of 
the  circulation  of  the  blood  (and  lymph)  it  was 
customary  among  doctors  to  resort  to  blood-letting, 
and  to  leeching,  as  well  as  to  blistering,  for  the 
relief  and  cure  of  diseases — and  yet  one  would  have 
thought,  a  priori,  that  at  least  the  two  former  of 
these  methods  depended  directly  upon  the  discovery 
of  the  circulation  of  the  blood,  and  would  appear 
useless  and  inept  without  it.  The  great  reason, 
indeed,  why  blood-letting  has  been  to  so  large  an 
extent  given  up  is  not,  in  my  opinion,  because  the 
discovery  of  the  circulation  militated  against  it — on 
the  contrary,  it  justified  and  encouraged  it,  if 
anything — but  because  it  came  to  be  recognised 
that  removal  of  a  quantity,  say  a  pint,  of  blood, 
while  it  might  to  that  extent  remove  some  of  the 
materies  morbi  of  disease,  could  have  no  influence 
on  the  rest  of  the  blood  in  the  body,  and  could, 
therefore,  do  nothing  towards  removing  the 
materies  morhi  or  materies  morhorum,  from  the 
remaining  10,  or  11,  or  12,  or  13  pints  of  blood  in 
the  body.  At  least  this  is  the  consideration  which 
ought  to  have  determined  the  cessation  of  blood- 
letting. But,  in  point  of  fact,  it  was  not  even  this 
which  did  so  determine  it,  but  a  feeling  that  men's 
bodies  were  weakened  by  the  process.  We  are  too 
apt,  it  seems  to  me,  in  considering  the  present  state 
of  knowledge,  and  comparing  it  with  that  of  past 
generations,  to  imagine  that  we  know  a  great  deal 
more  than  our  predecessors.     No  doubt  there  are 


140 

whole  domains  of  knowledge  within  the  power, 
more  or  less,  of  men  of  the  present  day,  which 
were  not  even  dreamed  of  in  past  times. 
Chemistry,  biology,  physiology  and  pathology,  e.g., 
did  not  exist  in  their  present  form  in  the  times  of 
Hippocrates,  or  Celsus,  or  Galen.  And  yet,  as  to 
conduct,  or  as  to  the  medical  management  of 
illness,  it  is  doubtful  whether  we  are  much  in 
advance  of  our  predecessors.  We  are  at  least,  I  feel 
sure,  not  so  much  in  advance  of  them  as  we  so 
often  and  so  complacently  suppose.  The  role  of 
the  progress  of  science  is,  after  all,  not  so  much,  or 
at  least  not  so  much  as  we  suppose,  to  point  out 
new  methods  of  inquiry  into  the  constitution  and 
course  of  nature,  as  it  is  to  corroborate,  by  the  use 
of  newer  and  more  accurate  methods,  what  we  may 
see  and  perceive  by  means  of  the  proper  use  of  the 
senses.  I  have  already  mentioned  the  feeling  of 
the  pulse  and  the  instruction  obtained  from  it  by 
men  who  knew  nothing  of  the  circulation  of  the 
blood  and  lymph,  and  I  will  now  mention  one  or 
two  other  ideas  known  to  the  ancient  physicians,  so 
that  we  may  be  able  the  better  to  gauge  the  truth 
of  what  I  am  saying.  The  most  ancient  obser- 
vation, perhaps,  in  medicine,  was  to  the  effect  that 
we  cannot  feed  the  sick  as  we  feed  the  well ;  and 
Hippocrates,  writing,  say  450  B.C.,  mentions  this 
as  an  observation  of  the  physicians  who  were 
"  ancient "  in  his  day,  that  is,  as  an  observation 
made  by  men  living  1000  or  1500  years  B.C. 
If  this  be  considered  an  observation,  so  trite   that 


141 

no  one  could  fail  to  notice  it,  what  shall  we  say  to 
the  observation  of  Hippocrates  himself,  already- 
mentioned  on  page  117,  that  less  food  is 
required  in  hot  weather  than  in  cold  ?  This 
seems  to  me  a  remarkable  observation  to  be 
made  by  a  man  who  lived  many  centuries 
before  chemistry  or  combustion,  or  the  relations 
between  heat  and  oxidation,  or  between  heat  and 
physiological  or  physical  energy  had  been  dreamed 
of.  But  he  saw,  and  correctly  saw,  by  observation, 
what  was  only  demonstrated,  or  let  us  say,  what 
had  new  experimental  light  thrown  on  it  many 
generations  later.  The  last  point  I  will  mention 
at  present  is  perhaps  the  most  important  of  all, 
and  it  is  an  observation  of  Hippocrates  to  the 
effect  that  people  ought  to  be  fed  in  proportion  and 
in  relation  to  the  work  they  have  to  do.  We  must 
inquire,  he  says,  "  whether  the  food  has  been  too 
much  for  the  work  to  be  done,  or  the  work  too 
great  for  the  food,  or  whether  they  have  been 
proportionate  one  to  the  other.  For  according  as 
one  exceeds  the  other,  diseases  set  in,  while  from 
their  equality  with  one  another,  health  arises." 
Although  there  has  been  so  much  "  advance " 
in  chemistry,  physics,  biology,  physiology,  and 
pathology,  I  think  my  friend  Dr.  Dewey  is  justified 
in  his  question,  whether  the  sons  of  medicine  have 
ever  given  to  the  world  physiology  of  equal  or 
greater  importance  in  these  nineteen  hundred  years 
since  Christ  ?  And  I  repeat  that  these  three 
observations  (with  others  I  could  mention),  tend  to 


142 

induce  and  corroborate  the  view  that  as  regards  the 
conduct  of  medicine,  the  progress  of  science  goes  to 
strengthen  us  in  forming  conclusions,  which,  by 
the  unaided  but  candid  use  of  the  senses,  we  could 
observe  and  know  without  her. 

As  bearing  on  the  circulation  of  the  blood  and 
lymph    and    its    relation    to    food-supply,    certain 
fundamental   considerations   arise   to   the   inquirer. 
As  a  circle  has  neither  beginning  nor  end,  or  as  it 
may  be  viewed,  if  we  are  so  minded,  as  all  beginning 
or   all   end  ;    so   in  studying  a  round  or  circle  of 
organic  processes,  all  mutually  connected  with  one 
another,  it  is  immaterial  at  what  process  or  point  in 
the  circle  we  commence  our  study — we  shall  return 
to  that  point  or  process  again.     Nevertheless,  there 
are  some  ways,  and  some  points  of  view,  from  which 
more  instruction  will  be   obtained  from  the  study 
of  the  mechanism  than  if  it  is  approached  in  other 
ways.     In  the  case  of  a  steam  engine  driving  looms 
or  wool-combing  machines,  it  is  immaterial  whether 
we  commence  our  study  of  its  action  at  the  shaft, 
which,    by    its    attachment    to    the    crank,    turns 
gearing   which   turns   leather   bands,    causing    the 
back  and  forward  movement  of  the  looms  and  the 
to-and-fro  movement   of  the   shuttles,   or  whether 
we    commence   our    study   at    some    other    point. 
Through  bands  and   driving   wheel  and   eccentric, 
through  piston  and  cylinder  and  boiler  and  the  fire, 
which  is  the  source  of  the  motion  of  the  machine 
and  of  the  mill,  we  come  back  to  the  point  from 
which  we  started.     But  it  is  more  illuminating  and 


143 

instructive  to  begin  with  the  fire,  and  proceed  to 
examine  boiler,  cylinder,  piston,  &c.,  than  in  other 
ways ;  or  even  to  commence  with  the  pump  which 
sends  the  water  into  the  boiler. 

The  analagous  method  by  which  the  organic 
processes  of  the  body  are  to  be  examined  in  order 
that  the  animal  machine  may  be  understood,  and 
the  best  work  provided  by  it,  is  through  a  study  of 
the  digestive  processes ;  and,  therefore,  a  very  short 
account  of  these  processes  must  be  inserted  here,  in 
order  to  draw  attention  to   them  a  little  more   at 
length,  and  so  that  we  may  be  better  able  to  under- 
stand and  appreciate  the  reasons  for  the  advice  to 
be   offered   regarding   the  times  and  quantities  of 
meals.      This   account,    though    popular,   must   be 
correct,  so  far  as  it  goes,  but  will  not,  of  course,  be 
so   elaborate  as  if   it  formed   part  of   a   technical 
course  of  physiology.     At  the  same  time,  it  should 
be  sufficient  to  enable  us  to  understand  the  round 
or  circle  of  the  bodily  mechanism.     First,  then,  the 
food,  being  taken  into  the  mouth,  undergoes  the 
action  of  mastication  by  the  teeth,  whose  function 
is  mainly  one  of   mechanical  trituration.     At  the 
same  time  (and  the  better  will  this  be  effected,  the 
more  completely  is  that  mastication  or  trituration 
and   grinding   by  the  teeth   performed),  the   food 
ought  to  be  slowly  and  well  mixed  with  saliva  in 
the  mouth,  coming  from  the  salivary  glands.     Foods 
have  been  divided,  since  the  time  of  Liebig,  the 
great  physiological  chemist,  who  died  in  1872,  into 
four    great    classes,   according    to    their    chemical 


144 

composition.  (1)  Those  foods  which  contain  nitrogen, 
and  are  called  proteids  or  nitrogenous  foods.  The 
most  important  examples  of  this  class  are  such 
foods  as  meat  and  flesh  of  all  sorts,  fish,  eggs,  milk, 
cheese,  the  cereal  grains,  and  pulses  belonging  to 
the  pea  and  bean  tribe.  (2)  The  group  of  foods 
represented  by  sugar,  arrowroot,  sago,  tapioca, 
&c.,  and  called  non-nitrogenous  or  carboniferous  or 
carbonaceous.  The  latter  names  are,  however, 
bad,  since  the  nitrogenous  foods  also  contain  a 
carboniferous  part.  With  the  division,  however,  of 
foods  into  nitrogenous  and  non-nitrogenous,  no  fault 
can  be  found,  although  the  notions  of  Liebig  have 
been  considerably  modified  by  subsequent  inquiries 
as  to  the  parts  played  by  the  difierent  kinds  of  food 
in  the  economy.  The  non-nitrogenous  foods  have 
been  divided  into  two  groups,  first,  the  sugars  and 
starches  already  referred  to,  and  secondly,  the  fats 
(oil,  butter,  cream  and  fat),  which  form  the  third 
division  of  food  stuffs.  The  first  division  of  foods, 
the  nitrogenous,  are  alone  capable  of  repairing 
completely  the  waste  of  the  body-flesh  or  muscle, 
since  it  contains  nitrogen  in  its  composition.  But 
although  the  carboniferous  or  carbonaceous  foods 
contain  no  nitrogen,  the  nitrogenous  foods  contain 
considerable  quantities  of  carboniferous  stuff,  and 
are  therefore  capable  of  performing  all  the  functions 
in  the  body  which  can  be  performed  by  the  non- 
nitrogenous  foods,  with  the  power  of  building  up 
again  the  nitrogen- containing  tissues  in  addition. 
The     great    function    which    the    non-nitrogenous 


145 

foods  perform  in  the  body  is  that  of  maintaining 
the  body-heat,  and  this  they  do  both  by  the  sugar 
and  starch  group  and  by  the  fats,  but  the  latter,  as 
we  see  from  the  use  made  of  them  by  denizens  of 
very  cold  regions  like  the  Arctic  and  Antarctic 
regions,  have  greater  power  in  maintaining  bodily 
heat  than  sugars  and  starches.  The  fourth  division 
of  food-stuffs  is  the  mineral  portion  made  of  salts 
of  alkalies  for  the  most  part,  as  compounds  of 
potash,  soda,  lime,  and  common  salt,  with  smaller 
quantities  of  sulphur,  &c.,  entering  into  their 
composition.  Lastly,  and  so  important  is  it  that 
we  may  consider  it  as  forming  a  fifth  division  of 
food  stuffs,  water  enters  largely  into  the  composi- 
tion, and  forms  from  two-thirds  to  three-fourths 
both  of  the  foods  used  in  the  body  and  of  the 
body  itself 

Now  the  saliva  coming  from  the  salivary 
glands  in  the  mouth,  and  being  there  well  mixed 
with  the  food,  has  little  or  no  action  on  the  proteid 
or  nitrogenous  part  of  the  food  proper,  has  little  or 
no  action,  e.g.,  on  fish,  flesh,  fowl,  or  eggs  or  cheese ; 
but  exerts,  on  the  other  hand,  a  very  considerable 
effect  on  the  non-nitrogenous  starches  and  also  on 
the  non-nitrogenous  portion  of  nitrogenous  foods — of 
bread,  for  instance,  or  of  rice — the  starch  of  which 
it  converts  into  grape  sugar.  Starch  must  be 
converted  into  grape  sugar  before  it  can  be  used  in 
the  economy,  so  that  the  need  for  good  chewing 
and  for  efficient  mixing  with  saliva  becomes  more 
apparent  from  this  consideration.  The  food,  being 
J 


146 

now    ready   for   swallowing,    is   passed    along    the 

gullet  (which  exerts  comparatively  little  action  on 

it)  into  the  stomach.     There  it  is  met  by  the  gastric 

juice,  considerable  quantities  of  which  (from  a  pint 

to  two  pints)  are  secreted  into  the  stomach  from  its 

walls,  each  time   that  food  is  taken.     The  gastric 

juice  is  sometimes  called  the  gastric  acid  because  it 

has  an  acid  reaction,  while  the  reaction  of  the  saliva 

is  alkaline.     A  proper  appreciation  of  the  fact  that 

so   much  gastric  juice  as  two  pints  is  poured  out 

when   a   meal    is    taken,    is    highly   important    in 

determining  the  quantity  of  food  that  ought  to  be 

taken  at  a  meal.     The  children  of  a  past  generation 

— the  advice  is  not  so  common  now  as  it  was  then, 

nor  so  common  as  it  ought  to  be — were  advised  to 

stop  eating  before  they  felt  that  they  had  had  as 

much  as  they  could  take,  or  before,  as  the  phrase 

was,  they  felt  full.     Now  this  was  very  wise  advice, 

for  if  we  go  on,  either  children  or  adults,  eating  till 

our  stomachs  are  full,  how  are  we  to  make  room  for 

the  pint  or  the  quart  of  extra  material  when  gastric 

juice   to   that   amount   has   been   poured   into  the 

stomach  ?     But  we  must  make  room  for  this  extra 

quantity    of    material,    because    the    presence    of 

gastric  juice   is   absolutely  necessary  if  food  is  to 

undergo  gastric  digestion  and  to  be  converted  into 

chyme.  There  can  be  no  doubt,  indeed,  that  the  too 

widespread  habit  of  eating  to  satiety,  even  if  it  is 

not  carried  quite  to  fulness,  is,  after  the  necessary 

amount   of    gastric   acid    has   been   added    to   the 

stomach  contents,  the  chief  cause  of  that  feeling  of 


147 

distress  and  weight  or  pressure  which  is  so  apt  to 
be  felt  by  all  of  us  from  half  an  hour  to  two  or 
three  [hours  after  eating  a  hearty  meal.  Taking  a 
less  amount  of  food  would  have  allowed  more  room 
for  the  necessary  gastric  acid,  and  would  have 
prevented  the  feeling  of  weight  and  heaviness. 
The  fact  also  incidentally  alluded  to  that  digestion 
in  the  stomach  goes  on  for  hours,  shews,  by  the 
way,  how  futile  is  the  advice  sometimes  given  to  us 
that  we  should  lie  down  for  say  half  an  hour  after 
taking  a  meal.  In  half  an  hour,  or  even  an  hour, 
the  digestion  of  a  townsman  or  townswoman  has 
reached  only  its  initial  stages,  and  if  it  is  necessary 
to  lie  down  half  an  hour  or  an  hour  after  eating,  it 
is  because  we  have  taken  more  at  the  meal  than 
was  good  for  us.  To  suggest  that  we  should  lie 
down  for  three  or  four  hours  after  eating  would 
probably  meet  the  case  ;  but  to  do  this  would  be  to 
behave  like  a  boa-constrictor,  and  would  be  to  raise 
eating  into  the  "chief  labour  of  life,"  while  no 
amount  of  physiological  rest  after  food  consumption 
could  ever  undo  the  evil  effects  of  over-ingestion  ot 
food,  especially  if  that  process  were  frequently 
repeated. 

Another  practical  conclusion  of  the  utmost 
consequence,  besides  the  one  just  come  to,  that  we 
ought  to  stop  eating  before  satiety  is  reached,  is 
that  we  ought  to  eat  slowly.  This  is  so  obvious 
that  it  ought  almost  to  be  unnecessary  to  state  it ; 
for  if  saliva  is  to  act  on  the  starchy  portions  of  our 
food,  it  must  be  well  mixed  with  the  food  in  order 

J2 


148 

to  do  so,  and  this  can  be  effected  only  by 
thoroughly  chewing  the  food  as  it  is  taken.  Very 
many  persons,  perhaps  even  a  majority  of  us,  make 
the  great  mistake  of  eating  too  quickly,  and  so  of 
failing  to  masticate  and  triturate  properly  the  food 
we  take.  Eating  slowly  is  in  fact  a  help  against 
the  error  of  eating  to  satiety,  because  we  have 
more  time  to  appreciate  the  state  of  fulness  that 
the  stomach  gets  into  after  ordinary  eating,  and  so 
we  are  helped  by  slow  eating  to  stop  before  we 
have  taken  too  much.  The  simple  device  of 
chewing  each  morsel  of  food  taken,  say  twenty 
or  thirty  times  (some  have  said  even  forty  times), 
before  swallowing  it,  would  greatly  help  towards 
forming  the  habit  of  slow  eating  ;  and  this  in  turn, 
as  it  would  greatly  aid  digestion  and  assimilation, 
blood-making,  and  tissue  nutrition,  would  have  the 
most  potent  influence  on  the  maintenance  of  health 
and  the  prevention  of  illness. 

The  gastric  juice  or  gastric  acid  acts  specially 
on  such  nitrogenous  foods  as  meat,  fowls,  fish  and 
cheese,  and,  helped  of  course  by  the  preceding 
action  of  the  saliva,  and  by  the  rolling  action 
exerted  by  the  muscular  walls  of  the  stomach 
itself,  converts  the  whole  contents  of  the  meal  into 
a  grey  grumous  fluid  mass  called  chyme.  Not  yet, 
however,  is  the  food  ready  for  absorption.  It  has 
to  be  passed  out  of  the  stomach  into  the  small 
intestine ;  and  immediately  on  its  reaching  this 
part  of  the  digestive  tract,  it  meets  with  the 
secretion  from  the  pancreas  and  that  from  the  liver. 


149 

These  secretions  have  again  an  alkaHne  reaction. 
The  former  finishes  the  digestion  of  any  starch 
which  may  have  escaped  the  action  of  the  saHva  in 
the  mouth,  converting  it  into  a  state  fit  for 
absorption,  either  directly  into  the  blood,  or 
indirectly  to  the  same  destination  by  means  of  the 
intestinal  villi.  These  last  structures  are  found  in 
the  small  intestine,  and  contain  each  a  small  lacteal 
vessel,  whose  mouth  opens  and  absorbs  some  particles 
of  chyle.  These  particles  are  passed  on  by  the 
lacteal  vessels,  and  find  their  way  into  the  thoracic 
duct,  in  the  way  to  be  immediately  described.  The 
action  or  influence  of  the  bile  from  the  liver  on  the 
other  hand  is  mainly  to  prevent  putrefaction  in  the 
highly  unstable  contents  of  the  digestive  tract,  and 
to  complete  the  digestion  of  particles  of  fat,  butter, 
cream,  &c.,  and  fit  them  for  being  mixed  with  the 
contents  of  the  small  intestines,  the  chyle.  This 
chyle  is  completely  elaborated  and  rendered  ready 
for  absorption  on  meeting  with  the  alkaline 
secretion  from  the  small  intestine  itself  Entering 
the  venous  blood  from  the  small  intestines,  it  is 
carried  by  the  portal  vein  to  the  liver,  while  some 
of  the  chyle-particles  enter  the  lacteals  and  thoracic 
duct,  being  emptied  by  it  directly  into  the  venous 
blood  at  the  root  of  the  left  side  of  the  neck.  This 
venous  blood,  if  we  follow  it  in  its  course,  will  be 
found,  by  means  of  the  superior  or  descending 
vena  cava,  to  be  carried  to  the  right  side  of  the 
heart.  How  much  of  the  chyle  finds  its  way  by 
means  of  the  portal  vein   to   the   liver,   and   how 


150 

much  by  means  of  the  lacteals  and  thoracic  duct  to 
the  superior  vena  cava,  does  not  seem  to  be  quite 
known.  In  any  case,  that  which  goes  to  the  liver 
after  being  laid  out  there  by  means  of  its  very 
extensive  circulation,  and  after  having  some  very 
important  changes  effected  in  it,  finds  its  way  back 
again  by  the  hepatic  vein  into  the  general  venous 
circulation,  so  that  in  time  all  the  chyle  is  emptied 
into  the  venous  blood,  either  directly  by  means  of 
the  thoracic  duct,  or  indirectly  through  the  portal 
circulation.  Being  carried  in  these  ways  to  the 
right  side  of  the  heart,  the  blood,  dark  and  venous, 
and  loaded  with  the  carbonic  acid  gas  and  other 
products  of  oxidation,  which  it  has  received  from 
the  tissues  as  it  was  passing  through  them,  is 
carried  by  the  pulmonary  artery  to  the  lungs  right 
and  left.  There  it  gives  up  its  carbonic  acid  gas  or 
carbon-dioxide,  and  takes  in  oxygen  from  the 
inspired  air,  changing  coincidently  its  colour  from 
crimson-black  to  scarlet.  There  ought  to  be  no 
oxidation  or  combustion  in  the  lungs  according  to 
the  laboratory  physiologists,  a  mere  passing  of 
carbon-dioxide  from  the  venous  blood  taking  place, 
accompanied  by  the  entrance  of  oxygen  from  the 
air.  But  when,  from  the  blood  containing  too 
much  material  in  it  from  unused  food,  an 
exudation  from  the  blood  has  taken  place  into  the 
mucous  membrane  lining  the  lungs,  or  into  the 
substance  of  the  lungs  itself,  it  may  happen  that 
oxidation  and  excess  of  combustion  does  occur  here 
as  in  any  other  inflamed  place  in  the  body.     When 


161 

this  is  so,  noj  doubt  the  limits  of  health  have  been 
transcended,  and  disease  has  set  in.  Physiology 
has  begun  to  shade  off  into  pathology.  But  this  is 
unfortunately  far  too  commonly  the  case,  pul- 
monary affections  or  diseases  of  the  respiration 
being  among  the  very  commonest  affections  of  the 
body.  The  figures  in  Chapters  II.  to  IV., 
regarding  the  incidence  of  disease,  show  how 
common  they  are. 

By  the  pulmonary  veins,  which  therefore 
contain  arterial  blood,  the  oxygenated  and 
depurated  blood  is  carried  back  from  the  lungs  to 
the  left  side  of  the  heart,  thence  to  be  distributed 
all  over  the  body  for  its  nourishment,  for  its  waste- 
repair,  and  for  building  up  its  strength.  We  see 
from  this  short  summary  how  the  function  of  food 
is  to  make  blood  and  to  enrich  the  blood,  and  how 
it  is  the  function  of  blood  to  nourish  the  body. 
It  is  only  therefore  by  ellipsis  that  we  can  speak  of 
the  function  of  food  as  being  to  nourish  the  body,  to 
repair  its  waste,  and  to  build  up  its  tissue.  The  food 
does  all  these  things,  but  not  directly  or  immediately, 
since  it  does  them  mediately  or  indirectly  through 
the  blood.  And  in  the  attempt  to  understand  the 
diseases  and  ailments  of  the  body  it  is  absolutely 
necessary  that  we  should  keep  these  steps  of  the 
processes  of  nutrition  and  of  digestion  separate  in 
our  minds.  By  means  of  this  consideration  also  we 
can  introduce  order  into  the  study  of  medicine  and 
of  diseases,  and  so  substitute  simplicity  for  chaos 
and   confusion.       The  multiplicity  of  diseases,    for 


152 

instance,  the  immense  number  of  them  which  come 
under  our  notice,  either  because  we  ourselves  or  our 
friends  or  acquaintances  are  suffering  from  them, 
are  apt  to  fill  us  with  despair  as  to  the  possibility 
of  our  ever  being  able  to  understand  them  or  see 
their  causal  connection.  But  let  us  once  get  into 
our  minds  the  facts  that  the  blood  goes 
everywhere  all  over  the  body,  and  that  the  blood 
is  made  by  changes  which  through  the  digestive 
processes  are  effected  in  the  food,  and  then  how 
simple  do  these  apparently  complicated  diseases 
become.  For  if  the  blood  goes  everywhere  all  over 
the  body,  then  it  may  nourish  the  various  parts 
properly,  if  it  is  itself  in  good  condition,  that  is,  if 
digestion  or  assimilation  has  been  properly  effected, 
and  if  the  proper  quantities  and  qualities  of 
material  have  been  poured  into  it ;  while,  on  the 
other  hand,  it  may  fail,  and  will  fail  to  nourish  the 
various  parts  properly,  if  it  is  itself  not  in  good 
condition,  that  is,  if  digestion  or  assimilation  has 
not  been  properly  effected.  In  the  former  case  the 
various  tissues  will  be  so  properly  nourished  that 
they  will  be  healthy ;  and  so,  as  they  are  acting 
normalty  and  painlessly  in  reference  to  their  various 
functions  in  the  body,  and  in  relation  to  one 
another,  we  remain  unconscious  of  their  very 
existence,  feeling  only  the  general  pleasurable 
sensation  of  health  and  well-being.  But  if,  on  the 
other  hand,  the  blood  going  to  the  various  bodily 
tissues  has  not  been  property  made  by  the  digestive 
processes ;  if,  for  example,  as  often  happens,   it  is 


153 

loaded  with  badly  assimilated  materials,  we  can 
easily  understand  how  it  may  deposit  in  any  of  the 
various  tissues  some  of  its  ill-formed  material,  and 
how  this,  by  disturbing  the  exercise  of  the  various 
functions  and  the  relations  of  these  functions  to 
one  another,  may  translate  itself  into  pain  and 
discomfort,  and  may  give  us  an  unpleasant 
consciousness  of  the  existence  of  parts  and  organs, 
which  knowledge  we  might  otherwise  have  been 
enabled  to  escape.  In  this  way  we  may  suffer  from 
bronchitis,  or  pneumonia,  or  pleuritis  (pleurisy), 
according  as  the  ill-made  and  waste-laden  blood 
deposits  an  exudation  into  the  mucous  membrane 
lining  the  lungs,  into  the  lung  tissue  itself,  or  into 
the  pleura  or  serous  membrane  covering  the  lungs. 
And  in  the  same  way  any  and  every  organ  and 
tissue  of  the  body  may  be  affected,  the  names  of  the 
affections  of  different  parts  being  as  various  as 
the  different  tissues  and  organs  themselves,  while 
their  various  symptoms  differ  from  one  another 
according  to  the  very  various  functions  of  the 
different  parts  affected. 

I  have  already  referred  shortly  to  the  portal 
circulation,  and  with  one  or  two  words  more  our 
sketch  of  the  blood-making  processes  may  be 
completed.  The  blood-vessels  which  come  from  the 
stomach  (where  probably  some  absorption  of  chyme 
takes  place,  although  the  mass  of  it  passes  on 
through  the  duodenum  into  the  small  intestine), 
those  blood-vessels  which  come  from  the  small 
intestine,    filled    with    the    products   of    digestion 


154 

there,  that  is,  with  the  chyle  ;  as  well  as  the  blood- 
vessels which  come  from  the  spleen  and  pancreas, 
join  together  to  form  the  portal  vein,  as  it  is 
called,  because  it  is  found  at  the  gate-way  or 
door- way  ( porta  =  gate  or  door)  so  to  term  it,  of 
the  liver.  The  portal  vein  carries  its  contents 
received  from  these  four  most  important  viscera,  the 
stomach,  the  small  intestine,  the  spleen  and  the 
pancreas,  to  the  liver,  which  is  the  largest  digestive 
viscus  and  one  of  the  most  important  organs  of  the 
body.  This  organ,  which  weighs  about  four  pounds 
when  out  of  the  body,  is  said  by  physiologists  to 
contain,  on  occasions,  about  29  or  30  per  cent,  of 
the  blood  contained  in  the  body  of  a  rabbit.  By 
generalisation,  this  proportion  is  supposed  to  obtain 
in  the  case  of  other  mammals  and  man.  Whether 
it  does  so  in  this  proportion  or  not  does  not  really 
very  much  matter.  What  does  matter  is  that  the 
liver  receives  through  the  portal  circulation  an 
immense  quantity  of  blood.  It  is  indeed  difficult 
to  believe  that  in  man  the  quantity  of  blood 
received  by  the  liver  can  reach  so  high  a 
proportion  as  30  per  cent,  at  any  one  time,  since 
this  would  imply  that  three  or  four  pints  out  of  the 
twelve  to  fourteen  pints  of  blood  contained  in 
the  body  would  be  in  the  liver  at  one  time.  As, 
out  of  the  body,  the  liver  weighs  about  four 
pounds,  the  addition  of  three  and  a  half  or  four 
pints  of  blood  would  increase  its  weight  to  about 
double ;  and  although  no  doubt  the  liver  differs 
from  itself  immensely  in  weight,  according  to  the 


155 

different  states  of  digestion,  it  is  not  easy  to 
believe  that  from  time  to  time  it  actually  doubles 
in  weight.  That  it  varies  very  much  indeed  at 
different  times  is  no  doubt  true,  and  is  all  that 
need  concern  us.  And  whoever  properly  appreciates 
this  fact  will  be  able  to  rate  at  its  proper  value  the 
statement,  for  example,  of  a  patient,  who  said  that 
his  doctor  had  been  able  to  reduce  the  width  of  his 
liver  by  about  an  inch  since  beginning  his 
attendance  on  him.  If  he  had  told  us  the 
comparative  times  of  digestion  at  which  the 
measurements  were  made,  we  should  have  been 
better  able  to  judge  the  value  of  the  statement ; 
but  that  an  empty  or  comparatively  empty  liver 
should  be  reduced  by  an  inch  when  it  had  been 
overgrown  or  hypertrophied  by  that  amount,  is  a 
statement  which  would  require  to  be  supported  by 
a  good  deal  of  evidence  before  it  was  accepted. 

While  I  am  on  this  subject  let  me  mention 
some  other  statements  of  the  physiologists 
regarding  the  facts  of  the  distribution  of  the  blood 
in  the  body.  These  facts,  let  me  repeat,  are  taken 
from  the  rabbit,  and  what  amount  of  weight  ought 
to  be  attached  to  them  when  applied  to  the 
circulation  in  man  must  be  carefully  considered. 
The  muscles,  they  say,  contain  about  30  per  cent, 
of  the  blood  also.  If  this  is  true  for  man,  then  we 
should  have  about  four  pints  of  our  blood  in  the 
muscles.  I  think  we  have  quite  that  proportion. 
On  the  enveloping  membranes  of  the  muscles, 
blood-vessels    are    carried    freely,    as   also  on  the 


166 

finer  forms  of  envelopes  which  surround  bundles 
of  muscular  fibres,  down  through  still  finer  and 
finer  processes,  till  we  finally  reach  the  finest 
coverings  of  all,  or  the  sarco-lerama,  as  it  is  called, 
enveloping  the  ultimate  muscle-elements.  On  all 
of  these,  arteries  finer  and  smaller  according  to  the 
increasing  refinement  of  the  enveloping  membranes, 
are  carried  till  they  are  lost  in  the  very  finest 
sarco-lemmatous  processes,  where,  however,  lymph- 
spaces  are  not  absent.  It  can  therefore  readily  be 
believed  that  four  pints  of  blood  or  more  are 
distributed  to  the  muscles  of  the  human  body. 
And  the  significance  of  this  seems  to  be  very 
great.  The  muscles  are  the  active  agents  of  the 
body,  or  the  agents  through  which  the  active 
powers  of  motion,  locomotion,  and  work  are 
performed.  It  is  likely,  therefore,  that  they  will 
require  a  large  supply  of  blood,  in  order  that  their 
active  work  may  be  possible ;  and  whether  this 
supply  amounts  to  30  per  cent,  of  the  whole  of  the 
blood  or  not,  it  is  evident  that  the  supply  of  blood 
to  the  muscles  is  free  and  abundant. 

Continuing  our  examination  of  the  blood 
distribution  in  such  an  animal  as  the  rabbit,  we 
come  upon  other  very  interesting  facts.  The  heart 
and  great  blood  vessels,  the  great  arteries  and  veins 
of  the  body,  with  the  addition  of  the  lungs,  do  not, 
say  the  physiologists,  contain  more  than  22  per 
cent,  of  the  total  volume  of  the  blood.  This  is 
very  curious  when  we  reflect  that  we  are  in  the 
habit  of  thinking  of  the  heart  and  vessels  as  the 


157 

organs  of  the  circulation  par  excellence.  If  this 
proportion  holds  in  the  case  of  man,  only  about 
three  pints  of  blood  out  of  his  fourteen,  or  only 
2*6  pints  out  of  a  total  of  twelve  pints,  will  be 
contained  in  the  heart,  blood  vessels  and  lungs  at 
any  given  time.  That  is  to  say,  the  blood-contents 
of  the  organs  of  circulation  and  of  respiration 
added  together  do  not  reach  the  amount  contained 
either  in  the  liver  or  in  the  muscles  (assuming,  of 
course,  what  is  not  certain,  that  what  is  true  in  the 
rabbit  obtains  also  in  the  case  of  man). 

The  physiological  significance  of  these  facts 
must  be  very  great,  and  we  may  reasonably  draw 
these  inferences  . — (1)  The  liver  exerts  an  enormous 
influence  on  the  blood-making  processes  ;  (2)  The 
muscles  play  a  great  part  in  the  blood  -  using 
processes.  In  order  that  they  may  do  the  work  of 
the  body  they  require  a  large  blood  supply,  which, 
if  they  are  active,  they  call  upon  the  food  to  supply. 
And,  no  doubt,  the  greater  the  muscular  activity  of 
the  body,  the  larger  wiU  be  the  amount  of  blood  in 
the  first  place,  and  of  food  in  the  second,  which 
they  will  require.  On  the  other  hand,  the  less  the 
bodily  activity,  and  the  lighter  the  muscular  work 
done,  the  less  blood  do  the  muscles  require,  and, 
therefore,  the  less  food.  Now  let  us  set  beside 
these  facts  another  one  also  vouched  for  by  the 
physiologists.  The  brain,  they  say,  of  a  rabbit, 
and  its  spinal  cord  together,  the  governing  and 
controlling  structures,  ordering  and  willing  so  far 
as  a  rabbit  can  govern  movements,  can  order  and 


158 

can  will,  can  think  and  can  feel,  the  cerebro- spinal 
nervous  system  contains  only  about  1  '5  per  cent,  of 
the  blood  within  it  at  any  given  time.  If  this  is 
true  of  man,  his  brain  will  contain  about  one-fifth 
of  a  pint  of  blood  out  of  the  twelve  or  fourteen 
pints  contained  in  his  whole  body.  It  may  be  said 
that  probably  the  brain  of  a  man  is  better  supplied 
with  blood  in  proportion  than  is  the  brain  of  a 
rabbit  ;  and  this  does  not  seem  to  me  an  unreason- 
able idea,  considering  what  very  different  work  a 
man's  brain  performs  from  that  done  by  a  rabbit's. 
But  if  the  human  brain  is  twice  as  well  supplied 
with  blood  in  proportion  as  a  rabbit's,  this  would 
only  give  two-fifths  of  a  pint  of  blood  in  the  human 
brain,  as  compared  with  three  or  four  in  the 
muscles  ;  while,  if  the  human  brain  contains  even 
5  per  cent,  of  the  blood,  as  compared  with  1'5  per 
cent,  in  the  rabbit,  this  would  only  amount  to  from 
three-fifths  to  seven-tenths  of  a  pint  of  blood. 
Even  then,  on  a  rather  high  and  free  computation, 
we  seem  to  be  driven  to  infer  that  the  brain  does 
not  require  a  large  amount  of  blood  for  the  conduct 
of  its  operations,  while  the  requirements  of  the 
muscles  are  very  considerable,  in  order  that  they 
may  perform  their  work,  at  the  same  time  that  the 
requirements  of  the  liver  for  the  purposes  of 
digestion  and  assimilation  of  food  are  very  great 
also.  The  supply  of  blood,  therefore,  seems  to 
require  to  be  large  in  order  that  the  lower  functions, 
so  to  call  them,  of  the  body,  the  functions  of 
locomotion   and  of   digestion,   should  be  well  per- 


169 

formed;  but  in  order  to  the  performance  of  the 
higher  functions  of  cerebral  activity,  ordering, 
feehng,  perceiving,  judging,  thinking,  reflecting, 
and  willing,  not  nearly  so  much  blood  seems  to  be 
required.  This  is  a  rather  remarkable  conclusion  to 
come  to,  but  I  think  it  is  a  sound  one  ;  and  there 
are  some  very  remarkable  physiological  facts  which 
point  in  the  same  direction,  and  appear  to  bear  it 
out.  For  instance,  it  is  surely  a  very  remarkable 
fact  that  although  the  blood  supply  all  over  the 
body,  and  in  all  its  parts,  except  the  brain,  is  and 
remains  under  the  government  and  control  of  the 
heart,  it  is  not  so  in  the  brain ;  but  the  blood  supply 
of  the  brain  passes  under  a  different  government 
whenever  the  internal  carotid  artery  enters  the 
lacerated  opening  in  the  temporal  bone  in  order  to 
pass  in  to  supply  the  brain.  Whereas  in  the 
common  carotid  artery  in  the  neck,  before  the 
internal  carotid  artery  branches  off  for  the  supply 
of  the  brain,  and  whereas  in  the  external  carotid 
artery  going  to  the  face  and  even  to  the  brain 
membranes,  and  in  all  the  other  arteries  of  the  body 
wherever  they  are  distributed,  the  circulation  is  and 
remains  sjmchronous  with  the  pulsations  of  the 
heart,  that  is,  heaving  at  the  rate  of  from  60  to  90 
times  a  minute,  the  motion  of  the  blood  in  the 
vessels  of  the  brain  itself  is  synchronous  not  with 
the  heart's  pulsations,  but  with  the  respiration,  i.e., 
it  heaves  and  throbs  and  moves  only  at  the  rate  of 
from  13  to  17  or  18  times  a  minute.  The  full 
significance   of  this   remarkable  arrangement  does 


160 

not  seem  to  be  appreciated,  but  it  appears  to  me 
not  unlikely  that  it  is  partly  at  least  because  the 
brain  does  not  require  a  very  large  amount  of  blood 
supply  in  order  that  it  may  perform  its  functions 
well,  and  that,  in  fact,  it  is  rather  hampered,  than 
otherwise,  and  hindered  if  a  very  large  supply  of 
this  fluid  is  sent  to  it.  Another  fact  seeming  td 
point  in  the  same  direction,  is  that  the  arteries  in 
the  brain  end  as  end  arteries,  each  to  its  own  small 
portion  of  cerebral  substance,  and  do  not  anastomose 
with  other  fine  arterial  endings,  going  to  neigh- 
bouring parts,  as  other  arteries  do  in  other  parts  of 
the  body.  The  object  of  this  may  be  to  ensure  that 
if  by  chance  a  fine  cerebral  vessel  becomes  blocked, 
the  disease  and  the  impairment  of  vitality  and 
power  consequent  on  this  condition  may  be  confined 
to  its  own  portion  of  cerebral  substance  and  be 
prevented  from  spreading  to  other  portions  of  the 
brain.  But  the  fact,  so  far  as  it  goes,  seems  to 
have  for  its  object,  or,  at  least,  for  its  effect,  the 
limiting  of  blood  supply  to  the  brain.  Now  as 
blood  is  made  from  food,  this  seems  to  mean  that 
persons  who  use  their  brain  largely  should  not  take 
much  food  lest  they  should  make  too  much 
blood,  which,  finding  its  way  in  too  great  volume  to 
the  brain,  might  cloud  and  interfere  with  the  finer 
and  subtler  working  of  that  governing  and  con- 
trolling and  thinking  and  feeling  organ.  This 
seems  to  be  a  remarkable  vindication  by  physiology 
and  anatomy,  of  the  correctness  of  insight  of  the 
poet  who  sang  that  there  was  a  close  connection 


161 

between  "plain  living  and  high  thinking."  The 
finer  functions  of  the  brain,  indeed,  do  not  seem  to 
be  performed  through  the  blood  supply  so  much  as 
secondarily  they  seem  to  be  associated  with  the 
formation  and  with  the  state  or  quality  of  the  fine 
lymph  which  is  found  in  all  the  brain  cavities  or 
ventricles,  as  they  are  called.  This  fine,  subtle, 
clear,  spirituous  fluid  exists  to  a  considerable  extent, 
especially  in  the  large  lateral  ventricles  in  the 
anterior  parts  of  the  brain,  as  well  as  in  the  smaller 
third  ventricle,  and  has  set  apart  for  its  production 
a  special  arrangement  of  blood  vessels  known  as  the 
choroid  plexuses.  (There  is  a  choroid  plexus  even  in 
the  fourth  ventricle.)  These  choroid  plexuses  are 
collections  of  blood  vessels  carried  on  prolongations 
of  the  finest  brain  membranes,  and  from  them 
seems  to  be  secreted  the  fine  spirituous  fluid,  which 
used  to  be  called  by  older  writers  animal  spirits, 
and  which  they  appear  to  have  thought  to  be  the 
medium  through  which  the  higher  powers  of  the 
brain  were  conducted.  As  this  fine  fluid  or  animal 
spirit  (the  animal  spirit  or  animal  spirits  we  see  to 
be  fundamentally  a  physical  fluid,  although  in 
mediaeval  and  modern  language  the  expression 
seems  never  to  be  used  in  this  sense,  but  always  in 
a  metaphysical  or  psychical  or  spiritual  sense)  is 
found  in  all  the  cavities  of  the  brain,  as  it  flows 
between  the  membranes  of  the  brain,  moistening 
and  lubricating  them ;  and  as  it  passes  even 
between  the  membranes  or  sheaths  of  the  nerves 
^also,  which  pass  out  from  the  brain  and  spinal  cord, 


162 

we  may  be  quite  certain  that  the  function  of  a 
fluid  so  widely  distributed  must  be  an  important 
one,  and  no  doubt  it  plays  a  great  and  important 
part  in  acting  as  a  medium  to  hold  intact  the  nexus 
between  the  brain  cells  and  the  more  or  less  remote 
parts  of  the  body,  which  in  so  remarkable  a  way 
recognise  the  authority  of  the  brain,  and  respond  to 
its  commands. 

But  it  is  now  time  to  consider  more  thoroughly 
the  nature,  and  character,  and  origin,  and  relations 
of  this  fine  spirituous  fluid  having  this  peculiar  and 
interesting  relation  to  the  brain  and  nervous 
system.  It  belongs  no  doubt  to  the  same  class  of 
secretions  as  are  found  all  over  the  body,  under  the 
name  of  lymph,  and  may  be  considered  as  a  finer 
form  of  the  same,  distilled,  so  to  say,  or  secreted 
from  the  choroid  plexuses  in  the  brain.  How 
important  the  lymph  is,  finer  and  coarser,  will  be 
apparent  when  we  reflect  that,  although  the  exact 
quantity  of  it  in  the  body  is  not  known,  it  amounts 
in  the  aggregate  to  probably  not  less  than  thirty  or 
forty  pints.  It  is  in  fact  not  unlikely  that  occasion- 
ally, or  even  frequently,  more  than  this  quantity  is 
present  in  the  body  of  an  average  sized  man,  who 
has,  on  the  other  hand,  only  twelve,  or  thirteen, 
or  fourteen  pints  of  blood.  This  fact  of  itself 
invests  the  lymph  and  its  circulation  with  great 
importance.  Let  us  try  to  realise  more  clearly  what 
the  lymph  is.  It  is  the  watery  or  clear  fluid  basis 
of  the  blood,  uncoloured,  or  very  slightly  coloured, 
and   it    contains    also    a    considerable    number   of 


163 

corpuscles,  some  not  larger  than  very  small  pin-point 
granular  masses,  and  some  a  little  larger,  some  not 
unlike  in  size  to  the  corpuscles  of  the  blood,  though 
not    coloured    red    like   them.     It   is   collected   in 
interstices   that    exist   between   the    layers   of   the 
tissues  of  muscle  sheaths.     There  are  spaces  also  in 
the  very  substance  of  connective  tissue,  like  muscle 
sheaths,   nerve   sheaths,    periosteum,    sarco   lemma, 
neuri  lennna,  &c.,  &c.,   and  in  these  spaces,  some- 
times lined  by  very  fine  layers  of  membrane,  called 
endothelium,  the  lymph,  or  watery  part  of  the  blood, 
collects.      From  these  interstices,  in  the  substance 
of    the   connective    tissue,    and    from    the    spaces 
between  its  layers,  the  lymph  is  conveyed  away  by 
channels    which,     gradually   becoming   lined,   form 
lymphatic    ducts    and    lymphatic     vessels,     which 
conduct  away  the  lymph  collected  in  this  way,   and 
take   it  to  structures,   called  lymphatic  glands,   of 
which  more  detailed  mention  must  immediately  be 
made.     Meantime,  we  must  bear  in  mind  that  the 
lymph  is  itself  collected  from  the  blood  after  the 
blood  has  been  carried  to  the  various  structures  of 
the  body,  in  order  that  it  may  nourish  them.     The 
arteries  which  convey   the  blood  to  these  various 
structures  (the  definition  of  an  artery  is  that  it  is  a 
vessel  which  conveys  hlood  from  the  heart,  while  a 
vein  is  a  vessel  which  conveys  blood  to  it),  break  up 
into  finer   and   finer  branches,    until   they  end   in 
capillaries,  wide  enough  only  to  convey  one  blood 
corpuscle  at  once.     The  blood  corpuscles,  conveyed 
in  this  way,  find  themselves  in  relation  with  the 

K2 


164 

ultimate  cells  of  the  tissues,  being  separated  from 
them  only  by  a  layer  of  the  finest  membrane, 
through  which  nutritional  changes  pass  between  the 
blood  corpuscles  and  the  tissues,  these  changes 
having  the  efiect  of  building  up,  repairing, 
strengthening  and  vivifying  the  tissues  so  as  to  fit 
each  different  form  for  the  performance  of  its  own 
special  function.  But  after  these  nutritional 
changes  have  been  effected,  and  after  the  blood  has 
parted  with  its  nutritive  materials  to  the  tissues, 
something  is  still  left  over,  and  this  something  is 
picked  up  in  the  form  of  lymph,  as  above  described, 
and  finds  its  way  first  into  lymph  spaces,  and  then 
into  lymph  ducts,  to  be  carried  further  into  the 
body,  where  we  must  now  follow  it.  The  lymph 
ducts  go  in  the  vertebrata  (there  is  no  lymph 
circulation  in  invertebrata,  we  are  told — the  true 
inwardness  of  which  fact  is  of  intense  interest)  to 
the  lymphatic  glands,  which  are  found  in  numerous 
places  in  the  body,  particularly  at  the  sides  of  the 
neck,  in  the  arm  pits,  and  in  the  groins,  as  well  as 
in  many  internal  parts,  as  the  roots  of  the  lungs, 
intestines,  &c.  Entering  these  lymphatic  glands, 
they  coil  about  in  an  intricate  manner  in  their 
interior,  and  an  important  elaboration  of  the  lymph 
must  occur,  because  after  it  has  passed  through 
these  glands,  it  is  found  to  contain  many  more 
corpuscles,  generally  also  larger  corpuscles  than  it 
contained  before  it  entered  the  glands.  In  some 
cases  the  lymph  passes  through  as  many  as  two  or 
three  of  these   glands  before  it  joins  the  thoracic 


165 

duct.  For  it  is  important  to  bear  in  mind  that 
the  lymph  is  carried  into  the  thoracic  duct.  Now 
as  the  thoracic  duct  contains  the  particles  of  chyle 
which  have  been  absorbed  by  the  viUi  and  lacteals 
of  the  small  intestines,  and  as  the  contents  of  the 
thoracic  duct  itself  are  poured  into  the  large  vein 
at  the  root  of  the  left  side  of  the  neck,  for  the 
purpose  of  being  mixed  with  the  blood,  in  order  to 
enrich  the  blood  and  enable  it  to  perform  its 
function  of  nourishing  the  tissues  of  the  body, 
and  repairing  their  waste,  it  is  evident  that  the 
lymph  also  assists  in  these  important  processes. 
The  lymphatic  vessels,  therefore,  may  be  considered 
as  existing  for  the  purpose,  or  at  least  chiefly  for 
the  purpose  of  collecting,  and  so  of  getting  used 
over  again  any  constituents  of  the  blood  whose 
powers  have  not  been  wholly  used  up  in  the 
nutritive  processes.  The  lymphatic  vessels  are  a 
part  Hterally  of  the  economy  of  nature,  which  will 
not  allow,  so  to  say,  if  she  can  avoid  it,  any  waste 
to  take  place  in  the  body.  Any  nutritive  materials, 
whose  powers  have  not  been  completely  exhausted, 
are  re-collected  by  these  vessels,  and  carried  by 
them  to  join  the  thoracic  duct  charged  with  the 
products  of  digestion,  so  that,  after  being 
elaborated  by  the  glands,  they  may  be  used  again 
in  the  body  without  waste.  The  flat  or  expanded 
structures,  in  which  the  lymph  spaces  and  the  lymph 
vessels  arise,  form  investments  and  supports  for 
most  of  the  organs  of  the  body.  They  are  called 
fibrous  tissues,  according  as  they  form  investments. 


166 

or  sheaths,  or  supports  for  muscles,  nerves,  bones, 
and  the  outside  of  joints ;  or  serous  membranes, 
according  as  they  form  investments  and  supports 
for  organs  like  the  lungs,  liver,  intestines,  heart, 
the  inside  of  joints  and  of  internal  organs 
generally.  Their  structure,  although  seemingly 
made  of  one  layer  of  fibrous  or  serous  tissue,  really 
consists  of  several  or  many  layers,  as  can  be  easily 
seen  when,  through  inflammation,  or  congestion,  or 
engorgement  with  lymph,  the  layers  have  been 
somewhat  separated  from  one  another.  In  between 
these  layers,  and  in  interspaces  which  are  scarcely 
visible  in  the  substance  of  the  individual  layers 
themselves,  the  lymphatic  system  of  vessels  begin, 
and  these  interspaces  become  filled  with  the  watery 
part  of  the  blood,  containing  also  white  granular 
and  corpuscular  particles,  after  it  has  been  squeezed 
out  of  the  organs,  and  particularly  when  it  has 
been  squeezed  out  of  the  muscles,  after  the  blood 
has  parted  with  some  of  its  nutrient  materials  for 
the  life  and  energy-supply  of  those  organs. 

Now  in  order  better  to  appreciate  the  part 
played  by  this  arrangement,  let  us  attempt  to 
realise  what  the  efiect  of  too  frequent  feeding  will 
and  must  be  in  the  body.  When  this  interest- 
ing arrangement  has  come  into  operation,  some 
hours  after  food  has  been  taken,  and  when  the 
lymphatic  vessels  are  engaged  in  picking  up 
this  watery  and  corpuscular  part  of  the  blood 
for  re-use  in  the  body,  let  us  suppose  that  the 
person    in    question    has   meantime   taken   another 


167 

meal.  There  is  the  most  unmistakable  evidence 
present  from  time  to  time  by  which  it  can  be 
demonstrated  that,  when  persons  are  engaged  in 
performing  the  light  duties  of  town  life,  food  has 
not  left  the  stomach  for  five  or  six  hours  (frequently- 
much  more  than  five  or  six  hours),  after  it  has  been 
taken.  Even  after  it  leaves  the  stomach,  let  us 
remember  that  some  considerable  time  longer  must 
elapse  before,  having  reached  the  small  intestine,  it 
has  been  taken  up  into  the  blood  in  the  form  of  chyle 
by  the  thoracic  duct,  or  by  the  portal  vein.  Now 
let  us  suppose  that  in  a  case  which  requires  five  or 
six  hours  for  gastric  or  stomach  digestion  to  be 
completed,  a  new  meal  is  taken  in  four  hours  after 
the  previous  one.  Let  us  suppose  that  a  person 
who  breakfasts  at  9  o'clock  takes  dinner  or  lunch  at 
12-30  ;  or,  since  digestion  is  probably  more  rapid  in 
the  forenoon  than  it  is  later  in  the  day,  let  us  ask 
ourselves  what  will  happen  if  a  person  who  has  had 
lunch  at  1-0  or  1-30  takes  afternoon  tea,  and  cake, 
and  bread  and  butter,  at  4-30  or  5-0.  Plainly 
before  one  meal  has  left  the  stomach  (not  to  speak 
of  the  small  intestine),  another  one  is  ingested 
some  hours  before  any  need  for  it  can  possibly  have 
arisen  in  the  economy.  Evidently,  therefore, 
before  digestion  of  the  previous  meal  has  been 
completed,  the  digestion  of  the  next  will  have  to 
be  begun,  and  more  gastric  juice  will  have  to  be 
poured  out  into  the  stomach,  before  the  previous 
contents  have  been  properly  dealt  with.  In  fact, 
digestion  will  be  going  on  at  two  different  stages  in 


168 

the  same  stomach  at  the  same  time.     Now  if  even 
it  be  admitted  that  this  might  conceivably  happen 
once  or  twice   without  doing    much    damage    (but 
even  once  or  twice  is  once  or  twice  too  often),   it  is 
quite  obvious  that  the  repetition  of  the  process  must 
be     most     deleterious.        Besides     the     fact     that 
digestion  is  going  on  at  two  different  stages  in  the 
same  stomach  at  the  same  time,  and  that  all  the 
other    digestive    processes    are    apt    to   be   simul- 
taneously    disarranged    by    the    same    or    similar 
causes,  we  must  consider  the  changes  effected   by 
the      same      causes      in     the     lymph     circulation. 
Obviously  too  much  lymph  must  be  finding  its  way 
into  the  blood  through  the  thoracic  duct.     Before 
one  supply  has  been  properly  elaborated  and  mixed 
with  the   blood   current,  another  supply  is  on  the 
way.      This  must  interfere  with  proper  assimilation 
m  the  first  place,  and  in  the  next  must  lead   to 
overloading  of  the   blood  with  excess  of  nutritive 
material.     Then,  nextly,  where  such  too  rich  blood 
has  been  carried  to  the  muscles  to  keep  up  the  heat 
of    the    body,    and    to    enable    them    to    perform 
mechanical  work,  there  will  be  a  larger  over-plus  in 
the  form  of   lymph  to  be  absorbed  by  the  lymph 
spaces,  and  to  be  thence  passed  on  to  the  lymphatic 
trunks,  by  them  to   be    carried   to   the   lymphatic 
glands  for  further  elaboration,   before  the  contents 
pass    on   to   be  poured   through  the  thoracic  duct 
back  again  into  the  venous  blood.     The  lymphatic 
vessels,  let  us  suppose,    do  this  work  well.     They 
rid  the  blood  of  material  which  is  unused,  and  pass 


169 

it  on  for  re-use  in  the  economy,  But  long  before 
they  have  succeeded  in  doing  this,  another  supply 
of  lymph  and  chyle  has  entered  the  thoracic  duct 
and  the  portal  vein,  and  from  these  has  been  poured 
into  the  blood.  The  blood  carries  it  all  over  the 
body,  and  particularly  to  the  muscles,  for  conversion 
into  heat  and  into  mechanical  work.  The  same 
round  re-commences,  the  same  overwork  is  thrown 
on  to  the  lymph  spaces,  and  the  lymph  vessels,  and 
the  lymphatic  glands.  The  muscles  become  heavy 
and  achy,  and  the  person  feels  languid  and  unable 
or  unwilling  to  move,  and  low  and  weak,  not  from 
taking  too  little  food,  but  from  taking  it  too 
often  and  too  much.  Nevertheless,  she  feels  weak, 
and  further  finds  herself  relieved  for  a  short 
time  by  taking  more  food,  the  heat  of  hot  tea 
(which  is  accompanied  by  bread  and  butter  or 
cakes)  stimulating  the  digestion  to  assimilate  some 
of  the  unused  stufi"  in  the  digestive  tract  and  in 
the  blood,  while  unfortunately  the  efforts  of  the 
lymphatic  system  to  relieve  the  blood  are  rendered 
nugatory  by  the  perpetual  re-ingestion  continually 
going  on,  at  too  short  intervals,  of  food  in 
excess  of  the  requirements  of  the  body.  Obviously 
the  economical  arrangements  of  nature  may  be 
opposed  or  thwarted  by  unphysiological  manage- 
ment. Before  the  lymphatics  have  had  time  to 
collect  the  lymph,  more  materials  for  lymph 
formation  have  been  ingested  into  the  body.  The 
new  digestive  processes  occur  too  soon.  Too  much 
material  finds  its  way  into  the  blood,  and,  especially 


170 

if  this  arrangement  is  repeated  frequently  and  at 

too  short  intervals,  it  is  evident  that  the  lymph 

spaces  may  become  blocked,  and  that  the  lymphatic 

glands  may  become  congested  and  inflamed.     When 

the   congestion  and   inflammation  proceed  further, 

pus-formation   or  suppuration    occurs,   and    in    this 

way  we  can  easily  account  for  those  enlargements  of 

the  glands  and  for  those  disfiguring  suppurations 

and     abscesses    in    the    neck    which    often    occur 

among     the    people,    and    especially    among    the 

children,  of  this  country.     In  the  same  way,  and 

from  the  same  causes,  the  lymph  spaces  in  a  serous 

membrane  like  the  pleura  or  that  lining  the  interior 

of  such  a  joint  as  the  knee,  may  become  over-filled 

with  lymph,  and  so  an  attack  of  pleurisy  or  pleuritis 

may  ensue,  or  a  white  swelling,  as  it  is  called,  may 

occur  in  the  knee  joint  of  a  child.     If  these  are 

theoretical  ways  in  which  such  diseased  conditions 

may  arise,  I  have  no  doubt  that  they  are  also  in 

most  instances  the  practical  ways  in  which  they  do 

arise.     A  curious  thing  is  that  in   the   diseases  I 

have  mentioned,  the  tubercle  bacillus  is  very  often 

found  to  be  concomitantly  developed  in  the  blood 

and  tissues,  and,  these  diseases  being  then  shewn 

to  be  of  a  tubercular  character,  are  looked  upon 

further  as  signs  or  marks  of  delicacy  of  constitution, 

as  the  phrase  is,  in  those  who  sufier  from  them.    It  is 

doubtful,  however,  or  more  than  doubtful,  whether 

this  is  a  just  view.     It  depends  on  the  definition 

we  give  to  the  term  constitution,  or  what  we  mean 

by  it.     If  by  constitution  we  mean  resistance,  then 


171 

it  would  not  be  inept  or  unsuitable  to  use  the  term 
as  meaning  simply  that  the  child  in  question  had  a 
somewhat  low  digestive  resistance,  and  that  in  this 
sense  he  had  a  weak  constitution.  But  if  we  mean 
(as  we  generally  seem  to  do)  that  the  original 
powers  of  the  person  were  too  weak,  that  somehow 
or  other  and  from  the  very  first  his  stamina  was 
poor  and  low,  and  much  below  the  average,  it  is 
more  than  doubtful  whether  we  are  justified  in 
using  the  term  constitution  in  this  sense  ;  and  for 
my  part  I  think  it  is  a  wrong  and  unjustifiable  use 
to  make  of  it.  The  question  of  constitution  and  its 
definition  will  come  up  for  discussion  later.  Mean- 
time, let  it  be  stated  that  it  is  not  suggested  that 
the  lymphatic  derangements  described  have  created 
the  tubercle  bacillus.  This  would  probably  be 
impossible,  or,  at  all  events,  a  most  unlikely  thing 
to  happen,  neither  man  nor  his  body,  nor  the  body 
of  any  other  organism,  plant,  or  animal,  being  able 
to  create  anything.  But  it  does  not  seem  at  all 
impossible,  or  even  unlikely,  that,  if  the  tubercle 
bacillus  were  in  the  body,  it  might  be  attracted  by 
the  increased  activity  going  on  in  those  lymph- 
engorged  parts  ;  and  that  it  might  there  set  up  its 
characteristic  actions.  Most  of  us  contain  in  our 
bodies,  most  probably,  numbers  of  these  bacilli  (and 
numbers  of  other  sorts  also),  but  so  long  as  we  are 
healthy  we  oxidise  them  off  and  take  no  harm,  or 
perhaps  they  lie  dormant  for  a  time  and  then  die. 
If  ingested  into  the  body  by  being,  for  example, 
eaten  in  meat  or  swallowed  in  milk,  we  can  easily 


172 

imagine  them  lying  dormant  in  the  body  so  long  as 
it  is  healthy  ;  but  when  excess  of  activity  has 
occurred  in  any  part  through  the  lymph  engorge- 
ment referred  to,  we  can  suppose  them  finding  their 
way  to  that  part,  developing  and  multiplying  there, 
because  they  find  the  pabulum  suitable  for  their 
growth,  and  so  from  that  place  they  may  find 
their  way  all  over  the  body ;  and,  setting  up  their 
characteristic  actions,  may  in  this  way  destroy  the 
body.  If  this  suggestion  seems  far-fetched  to  any 
reader  of  these  remarks,  let  me  remind  him  of  what 
takes  place  in  agriculture  when  we  treat  with  basic 
slag  grass  land  producing  no  clover,  or,  at  least,  so 
little  that  it  escapes  our  notice.  For  some  years 
after  grass  land  has  been  treated  in  this  way,  fine 
crops  of  clover  are  grown  where  no  notable  amount 
of  clover  grew  before,  and  not  only  so,  but  the 
weight  of  the  grass  crop  is  very  much  increased. 
Now  the  basic  slagr  did  not  contain  the  clover  seed. 
Being  manufactured  in  the  process  of  making  iron, 
it  was  white  hot  at  one  stage  of  the  process  of  its 
production,  and  nothing  living  could  survive  such  a 
condition.  Unless,  therefore,  the  clover  seed  had 
been  added  to  the  basic  slag  at  some  time  after  its 
production,  it  could  not  possibly  contain  any  ;  and, 
of  course,  we  know  very  well  that  this  was  not 
done.  The  clover  seed  must,  therefore,  have  been 
in  the  ground,  or  it  could  not  have  grown.  In 
some  way,  therefore,  the  addition  of  the  basic  slag, 
while  not  containing  the  clover,  modified  the 
conditions   of    the   soil   and   caused    to  thrive  the 


173 

clover  which,  perhaps,  before,  managed  to  live  some 
sort  of  a  weak  life,  being  possibly  kept ,  down 
though  not  destroyed  by  the  grasses  among  which 
it  grew,  until  the  addition  of  the  basic  slag  some- 
how altered  its  environment  and  made  it  thrive. 
The  precise  form  of  the  explanation  is  immaterial 
to  the  argument.  What  is  material  is  that  the 
addition  of  a  manure  not  containing  clover  seed  made 
clover  grow  where  it  was  practically  unknown  before. 
There  might  be  other  explanations  as  to  how  this 
occurred.  But  however  this  may  be,  who  does 
not  see  the  close  analogy  between  the  facts  of 
clover  production  in  this  way  and  the  causing  to 
thrive,  in  the  body  of  man  or  animals,  the  hostile 
micro-organisms  of  the  tubercle  bacillus  ?  That  in 
the  case  of  the  agricultural  experiment  we  wished 
the  seed  to  thrive,  and  that  in  the  case  of  the 
tubercle  bacillus  we  did  not,  is  beside  the  argument, 
which  is  on  the  other  hand  to  this  effect,  that  when 
we  alter  the  soil  (by  manuring  land,  or  feeding  the 
animal  body,  as  the  case  may  be),  we  alter  the 
conditions  or  the  environment,  ^and  so  organisms 
spring  up  which  did  not  formerly  do  so,  or  if  they 
did  spring  up  before,  did  not  come  to  the  matui'ity 
of  development  which  they  subsequently  attained. 
To  account  for  the  original  origin  of  the  tubercle 
bacillus,  or  of  any  other  organism,  is  part  of  the 
problem  of  creation,  and  transcends  the  wit  of  man ; 
but  to  account  for  the  presence  of  the  tubercle 
bacillus  in  any  given  place  may  or  may  not  be 
difficult,  and  as  it  generally  lies  within  the  powers 


174 

of  human  investigation  and  explanation,  may 
profitably  occupy  us.  To  decide  whether  organism 
or  environment  was  first,  to  say  whether  the  hen  or 
the  egg  was  first,  whether  day  was  before  night  or 
night  before  day,  to  declare  whether  structure  was 
before  function  or  function  was  before  structure, 
are  problems  which  transcend  the  powers  of 
human  faculty.  It  is  not,  however,  essential  to 
our  happiness  or  comfort  in  this  wonderful  and 
practically  infinite  universe,  extending  beyond  the 
utmost  stretch  of  our  imagination  in  all  conceivable 
directions,  that  we  should  be  able  to  solve  these 
mysterious  questions.  It  is  enough  for  us  that  we 
should  see  that  organism  and  environment  are 
co-ordinated  and  co-related,  that  as  the  one  alters 
so  does  the  other,  that  as  the  other  alters  so  does 
the  one,  to  see  that  hen  and  egg  and  egg  and  hen 
follow  one  another  in  invariable  sequence,  and 
evidently  have  done  so  for  an  indefinite  time  in  the 
past,  as  we  may  assume  that  they  will  continue  to 
do  so  for  an  indefinite  length  of  time  to  come  ;  that 
similarly  day  and  night  follow  one  another  in 
invariable  succession,  and  form  part  of  the 
arrangements  of  the  universe,  so  far  as  we 
have  to  do  with  it ;  and  that  structure  is  co- 
ordinated with  function  and  function  with  structure 
in  such  a  way  that,  as  one  alters,  so  does  the 
other  in  a  corresponding  manner.  In  the  same 
way  we  may  perceive  that  the  tubercle  bacillus 
tends  to  grow  in  tissues,  whose  activity  is 
heightened  by  the  long  continuance  of  inflammatory 


175 

blood  congestion  and  lymph  congestion  in  them, 
whatever  may  have  been  the  original  way  in  which 
its  existence  may  have  been  brought  about ;  and 
this  knowledge  carries  with  it,  or  may  carry  with 
it,  the  practical  conclusion  that  we  may  be  able  to 
prevent  the  growth  of  that  and  other  micro- 
organisms in  our  bodies,  if  we  see  to  it  that  these 
bodies,  besides  being  properly  treated  as  regards 
air  and  exercises,  have  also  their  food  nutrition 
properly  managed,  by  being  supplied  with  neither 
too  much  food  nor  too  little,  and  by  being  fed 
neither  too  often  nor  too  seldom,  in  conformity 
with  the  work  and  the  kind  of  work  which  they 
are  called  upon  to  do. 

I  have  in  this  chapter  set  forth  the  anatomical 
and  physiological  facts  of  the  circulation  of  the 
blood  and  lymph,  which  seem  to  have  a  bearing  on 
the  advice  offered  in  these  pages,  at  any  rate  to  the 
average  townsman  and  townswoman,  that  they 
should  rather  tend  to  restrict  than  to  increase  their 
diet.  I  deal  here  rather  with  the  theory  on  which 
the  advice  is  founded.  Later,  and  particularly  in 
Chapter  VIII. ,  the  subject  is  dealt  with  more  from 
the  practical  standpoint.  Until  he  reaches  that 
Chapter,  therefore,  the  reader  will  perhaps  be  kind 
enough  to  let  the  subject  rest,  and  turn  itself  over 
quietly  in  his  mind ;  and,  meantime,  I  pass  on  to 
the  consideration  of  the  two  great  medical 
paradoxes. 


176 


CHAPTER   VI. 


Some   of   the   Paradoxes   of   Medicine. 


T  DO  not  know  that  I  can  introduce  the  considera- 
tion  of  this  interesting  and  important  part  of 
my  subject,  or  perhaps  help  to  clear  up,  as  I  hope 
to  do,  some  of  its  puzzling  confusion,  better  than  by 
relating  the  following  occurrence.  A  lady,  who 
is  much  interested  in  medical  questions,  asked 
me  recently  this  question:  "Can  you  give  me," 
said  she,  "any  unequivocal  sign,  doctor,  of  under- 
feeding ?  any  one  unequivocal  sign  by  which  I  may 
know  that  either  myself  or  my  children  are 
under-fed  ?  "  On  hearing  such  a  question  the  first 
idea  that  occurs  to  one  is,  how  simple  is  the 
question  and  how  easy  the  answer.  Thinness,  for 
instance,  wasting,  attenuation,  general  depression, 
languor,  lowness  of  temperature,  slowness  of  pulse, 
inactivity  of  function,  weakness  —  all  these  one 
would  think  to  be  marks  so  obvious  of  under- 
feeding as  to  cause  surprise  that  the  question  was 
asked  at  all.  But,  in  point  of  fact,  the  answer  to 
the  question  is  so  dijQ&cult — at  least  it  proved  to  be 
so  for  me — that  I  was  obliged  to  reply,  "  I  cannot 
mention  any  unequivocal,  or  as  it  might  be  called, 
pathognomonic,    sign    of    under-feeding."     For   the 


177 

curious  and  even  paradoxical  thing  is  that  all  the 
signs  mentioned — the  thinness,  the  wasting,  the 
lowness,  the  inactivity,  the  languor — while  they  may 
sometimes,  no  doubt,  be  marks  of  under-feeding, 
and  occasionally  are  so,  may  also  be,  and,  in  fact, 
when  met  with  in  practice,  most  commonly  are, 
marks  or  signs,  not  of  under-feeding,  but  of 
over-feeding.  When  men  are  exposed  in  a  boat 
after  the  wreck  of  their  ship,  for  many  days,  with 
only  a  few  days'  provisions  on  board,  we  know 
that  when  saved  they  will  be  thin,  wasted  and 
attenuated,  that  they  will  be  weak,  that  their 
pulse  may  be  slow  (or  quick),  their  temperature 
probably  low,  and  their  bodily  functions  generally 
in  abeyance.  Mark  Twain  has  described  to  us, 
from  the  layman's  standpoint,  in  his  essay  "  How  I 
made  my  debut  as  a  literary  person,"  how  there  had 
been  no  action  of  the  bowels  for  twenty  and 
thirty  days  in  the  case  of  men  subjected  to  these 
conditions.  In  one  case,  he  tells  us,  the  duration  of 
the  constipation,  including  a  period  of  time  after 
the  man  was  saved,  was  no  less  than  forty-four 
days.  "Sleep,  also,"  he  says,  "came  to  be  rare, 
but  the  men  did  very  well  without  it."  In  one 
stretch,  the  captain  did  not  sleep  for  twenty-one 
days  and  nights.  The  functions  of  intestinal  action 
and  of  sleep  were  in  abeyance,  or  absent,  for  a 
very  long  time. 

Now  there  could  be  no  doubt  what  the  cause 
was  in  these  cases.  The  cause  was  direct  starvation, 
so  long- continued,  and  with  consequences  so  marked, 


178 

that,  had  it  gone  on  for  only  a  little  longer  time,  the 
men  must  have  died.  And  consequently,  after  the 
men  had  been  saved,  the  obvious  treatment  for 
them,  the  only  rational  thing  to  do,  was  to  have 
recourse  to  cautious  and,  of  course,  not  too  suddenly 
increased  administration  of  food.  And  this  would 
have  to  be  continued,  as,  in  fact,  it  was  continued, 
until  the  men  gradually  returned  to  normal  and 
healthy  food  habits,  properly  proportioned  to  the 
work  which  they  had  to  perform.  All  this  is  perfectly 
plain  and  obvious  to  the  meanest  comprehension. 
But  we  should  make  the  greatest  mistake  if  we  were 
to  assume  that  because  attenuation,  constipation 
and  sleeplessness  were  in  these  cases  caused  un- 
doubtedly by  too  little  food  for  a  long  continuance 
of  time,  they  are  always  so  caused.  And  if,  acting 
on  this  view,  we  were  to  recommend  a  patient 
suffering  in  these  ways  to  increase  his  food,  we 
should  or  we  might  find  his  attenuation  getting 
worse  and  his  constipation  and  insomnia  increasing. 
Constipation  is  inactivity  of  intestinal  function,  and 
it  may  be  brought  about  in  two  opposite  ways,  or 
from  two  contrary  causes,  by  deficiency  of  food  and 
by  excess  of  food.  In  the  one  case  constipation  is 
induced  for  two  reasons,  first,  because  there  is 
nothing  to  pass — the  intestines  have  no  contents, 
they  are  quite  empty — and  second,  because,  if  there 
were  anything  to  pass,  there  is  no  strength  to  void 
it.  But  in  the  other  case,  constipation  or  intestinal 
inactivity  sets  in  because,  there  being  too  much 
to   pass,  the  intestines   become   dry  and   plugged. 


179 

Obviously,  while  the  treatment  proper  to  the  first 
form  of  constipation   is  to  cautiously  increase  the 
diet  till  we  get  the  man  on  to  proper  food  habits 
(when  his  constipation  will  begin  to  disappear),  the 
treatment  proper  to  the  second  form  of  constipation 
is    to    cautiously    restrict    the    diet    in    the    way 
described    in    Chapter    III.       The    first    form    of 
constipation   is   caused   by    direct    starvation,    and 
by   the  direct   weakness   which  it   brings    on,   but 
the   second  by    causes  just  the   opposite   of  this; 
and  I  have  already  described  the  modus  operandi 
in     which    it    comes    about.       Reflection     on    the 
causes  of  the  condition  also  shews  the  futility  of 
treating  such  a  state  by  purgatives.     These  only 
irritate  the  bowel,  causing  an  increase  of  watery 
discharge    from   it    by   increased    stimulation    and 
irritation ;   but   when    these   subside,    unless   other 
measures    are    meantime    taken,    and    particularly 
unless  the  diet  is  restricted,  the  constipation  is  not 
and  cannot  be  relieved.     In  fact,  it  is  apt  to  become 
aggravated,  because  the  irritation  of  over-action  or 
over-secretion,  set  up  by  the  purgative,  is  apt  to  be 
followed  by  a  corresponding  diminution  of  activity, 
or   by   under-secretion,    which   makes   the   original 
trouble   worse.       Unless    the    person    so    suffering 
consents  to  restrict   his   diet — and,   unfortunately, 
too  few  persons  are  advised  to  do  this,  or,  if  advised, 
unfortunately  refuse  to  do  it,   so  persistent  and  so 
widespread  and  prevalent  are  wrong  ideas  on  the 
subject — he   cannot   get   rid   of   his  trouble.     And 
hence  we   see   those  frequently  recurring  cases  in 

L2 


180 

which  persons  have  recourse  to  the  use  of  purgatives 
for  many  years  without  being  able  to  obtain  relief 
from  their  misery.  Instances  have  occurred  within 
my  knowledge  in  which  patients  have  taken  aperients 
every  day  for  25  years,  and  even  longer,  without 
succeeding  in  obtaining  cure  of  their  ailment.  It  is, 
I  confess,  a  standing  puzzle  and  mystery  to  me  how 
this  state  of  things  can  continue.  One  sees  persons 
capable,  in  other  directions  of  life,  of  grappling  with 
difficulties,  and  of  adapting  suitable  means  to  the 
end  of  ridding  them  of  their  troubles ;  but  in  a 
case  like  this  it  is  not  so.  Day  after  day  the 
difficulty  recurs,  the  constipation  shews  no  sign  of 
yielding  to  the  means  adopted  for  its  relief.  In 
order  to  meet  this,  perhaps  the  purgative  is 
changed,  cascara  is  replaced  by  liquorice  powder, 
or  one  form  of  patent  pill  by  another,  or  one 
mineral  water  by  another,  Hunyadi  Janos  by  hitter 
wasser  or  Friederichshalle  ;  or  the  dose  is  increased. 
A  patient  once  told  me  that,  beginning  with  one 
pill,  which  had  a  decided  effect,  he  soon  found  it 
necessary  to  take  two,  then  three,  and  then 
four,  and  so  on,  until  at  the  time  I  saw  him  he 
was  sometimes  taking  as  many  as  eighteen,  and 
occasionally  even  this  dose  had  no  effect.  This  had 
been  going  on  for  fourteen  years.  How  any  sensible 
man  or  woman  fails  to  discover,  after  say  six 
months,  that  there  is  no  relief  to  be  got  in  this 
way,  and  how  it  is  that  he  still  persists  in  futile 
efforts  of  this  kind,  is  a  puzzle  to  me.  In  any 
other  direction  in  life,  he  would,  when  he  found  one 


181 

means  fail,  try  another,  but  in  this  he  goes  on  in 
the  most  fataHstic  way  with  the  same  means, 
or  with  means  of  the  same  kind,  although  time 
after  time  he  finds  his  remedies  fail ;  or,  if  he 
obtains  temporary  relief,  the  evil  soon  recurs, 
even  perhaps  in  an  aggravated  form.  The  patient 
above  referred  to  told  me  a  year  after  our 
interview  that  he  had  only  once  taken  a  dose  of  an 
aperient  medicine  during  the  preceding  twelve 
months,  changes  in  the  diet  having  effectively  cured 
the  constipation,  which  no  aperients  could  do  more 
than  temporarily  relieve.  But  this  patient  did  not 
hesitate,  when  advised  to  do  so,  to  reduce  his  meals 
to  two  a  day,  and  to  make  some  changes  in  the 
quality  of  his  diet. 

How  serious  this  condition  may  become, 
however,  and  how  serious  in  point  of  fact  it  often 
does  become,  may  be  seen,  among  other  instances,  in 
the  case  of  cancer  of  the  bowel,  supervening  from 
this  cause,  the  overgrowth  of  the  muscular  fibre  at 
some  particular  point  in  the  bowel  becoming  greater 
and  greater,  until  at  last  it  becomes  so  great  that  it 
contracts  so  tightly  as  to  prevent  any  contents  from 
passing,  and  an  attack  of  intestinal  obstruction  sets 
in,  which  puts  the  patient  into  the  greatest  danger, 
and  may  even  cost  him  his  life.  Even  if  he 
survives  one  such  attack,  the  causes  still  continuing, 
and  too  much  nutritive  material  continuing  to  find 
its  way  into  the  blood,  and  thence  to  be  conveyed 
to  the  bowel  itself,  another  attack  is  sure  to  occur, 
followed  by  another  and  still  another.     In  the  end 


182 

what  is  called  malignant  disease,  and  what  is  at 
least  incurable  disease,  sets  in.  The  overgrowth, 
though  general  over  the  whole  bowel,  is  usually 
much  more  pronounced  at  one  point  or  place  than  at 
the  rest,  and  from  this  place  an  aggressive  or 
invasive  action  sets  in  in  the  surrounding  tissues, 
and  indeed  in  the  whole  intestines,  involving  them 
in  similar  action,  so  that,  even  if  the  chief  place 
afiected  is  cut  out  or  exised,  and  if  the  patient 
survives  the  operation,  other  parts  have  been  for  a 
long  time  steadily  prepared  for  taking  on  a  similar 
action,  they  may  take  it  on  accordingly,  and  cure  for 
that  person  may  become  impossible.  People  some- 
times say  that  constipation  causes  cancer.  What 
has  been  said  explains  what  they  mean ;  but 
obviously  a  truer  and  sounder  statement  would  be, 
not  that  constipation  causes  cancer,  but  that  the 
causes  of  constipation  are  frequently  also  the  causes 
of  cancer.  On  both  views,  of  course,  the  practical 
inference  would  have  been  drawn  that  if  the  consti- 
pation had  been  cured,  the  cancer  would  not  have 
occurred ;  but  on  the  former  view,  the  futile  plan  of 
attempting  to  cure  the  constipation  by  administering 
purgatives,  would  probably  have  been  had  recourse 
to,  while  on  the  other  view,  the  much  better  and 
much  more  hopeful  plan  would  have  been  adopted  of 
restricting  the  diet.  The  discussion  of  the  causes  of 
constipation  has  led  to  a  short  digression  as  to  how 
constipation  is  often  connected  with  incurable 
disease,  like  cancer ;  but  the  statement  I  wish  to 
emphasize,  and  which  I  think    I   have   proved   by 


183 

probable  evidence,  the  best  sort  of  evidence  which 
can  be  brought  to  bear  on  the  case,  is  that  opposite 
causes  acting  on  the  body  may  and  do  induce  the 
same  effect.  Constipation,  obstinate  and  lasting  as 
we  have  seen  (illuminating  and  rendering  much 
more  instructive  the  layman  Mark  Twain's  perfectly 
correct  description),  for  as  long  as  44  days,  may 
arise  from  too  little  food  ;  and  it  may  also  be  caused, 
as  in  fact  it  far  more  commonly  is,  by  too  much. 

It  is  not  quite  relevant  to  the  phase  of  the 
subject  under  discussion,  perhaps,  but  this  seems 
nevertheless  a  suitable  place  to  introduce  another 
consideration  bearing  on  this  subject.  The  person 
referred  to  as  having  taken  all  those  pills  told  me 
that  his  mother  had  died  of  cancer.  From  inquiry 
it  appeared  that  it  had  come  on  with  prolonged  and 
recurring  attacks  of  constipation,  which  it  had  been 
fruitlessly  attempted  to  relieve  by  administering 
purgatives.  Now  suppose  that  my  patient  had  also 
gone  on  in  the  same  way ;  suppose  that  he  had 
persisted  in  attempts  to  cure  his  constipation  by 
efforts  which,  in  the  nature  of  things,  could  not 
have  been  successful,  and  supposing  that  as  a 
consequence  he  had  got  cancer  also — well,  we 
should  have  been  apt  to  say  that  cancer  was 
hereditary  in  that  family.  And  yet  no  more  would 
have  been  proved  than  that,  like  causes  having 
acted  on  like  organisms  for  two  generations,  like 
results  had  been  produced.  Organisation  is  trans- 
mitted, no  doubt,  but  disease  hardly  or  very  rarely 
indeed.     And   in  the  case   supposed   there   would 


184 

have  been  no  more  proof  of  the  hereditary 
transmission  of  cancer  than  there  would  be  for  the 
belief  that  death  by  gunshot  wound  or  rifle  bullet 
is  hereditary  in  a  family  because  son,  father,  and 
grandfather,  having  been  mihtary  officers,  were, 
one  after  the  other,  shot  in  action.  If  the  son  of 
the  last  becomes  a  wool  merchant,  the  probabilities 
are  that  he  will  die  in  his  bed.  And  if  my  patient 
treats  his  constipation  differently  from  the  way  in 
which  his  mother  treated  hers,  there  is  no  reason 
why  he  should  have  cancer  like  her. 

I  have  said  that  probable  evidence  is  the  best 
sort  of  evidence  that  can  be  brought  to  bear  in 
cases  of  this  sort.  The  reader  may  demur  to  this, 
and  may  ask  for  experimental  evidence.  Well, 
what  better  experiment  could  be  devised  than  the 
experiment  of  civilised  nature,  as  it  may  be  termed, 
of  starving  men  in  a  boat  for  many  days,  if  we 
want  to  find  out  one  of  the  causes  of  constipation  ? 
And,  on  the  other  hand,  what  better  experiment  can 
we  desire  as  to  the  causes  of  the  ordinary  and  common 
form  of  constipation  than  watching  the  effects  of 
the  food  habits  of  ourselves  and  our  friends  ?  But  if 
minds  are  so  constituted  as  to  be  dissatisfied  with 
this  kind  of  evidence,  let  them,  if  they  are  so 
minded,  and  if  they  can  get  persons  to  submit  to 
the  experiments,  subject  their  friends  (or,  better 
still,  themselves),  to  a  long  course  of  fasting  on  the 
one  hand,  and  to  a  long  course  of  too  frequent  and 
too  abundant  feeding  on  the  other.  Constipation 
will  arise  in  both  experiments.     They  will  find  that 


185 

opposite  causes  induce  (apparently)  the  same  state. 
Let  them  weigh,  and  measure,  and  time  the 
quantities  of  food  administered,  let  them  note  its 
qualities  and  kinds  as  well.  Then  they  will  be  able 
to  conclude  that  certain  quantities  of  food  of  certain 
kinds,  administered  at  certain  times,  will,  as 
a  rule,  and  within  certain  limits,  induce  constipation, 
but  that  the  powers  of  resistance  of  different 
individuals,  and  of  the  same  individuals  in  different 
circumstances,  will  vary  very  much  in  the 
manifestation  of  the  effect.  The  net  result  will  be 
the  view  that  the  quantity  and  quality  of  food,  and 
the  times  of  its  administration  which  will  induce 
constipation,  cannot  be  stated  to  a  nicety,  but  that, 
on  the  whole,  frequent  and  abundant  feeding  tends 
to  induce  it.  In  fact,  the  evidence  to  be  obtained 
from  the  artificial  experiment  will  coincide  with 
that  from  the  natural  experiment  or  experiment  of 
nature,  which,  if  we  had  carefully  and,  as  far  as 
possible,  accurately  observed  it,  would  have  led  us 
to  the  same  conclusion.  And  a  general  rule  would 
arise,  the  same  as  observation  has  already  led  to, 
viz.,  that  the  quantity,  and  quality,  and  frequency 
with  which  foods  would  have  to  be  administered  in 
order  to  induce  constipation  cannot  indeed  be  stated 
to  a  nicety,  but  that  taking  it  too  much  and  too 
often  is  a  very  potent  cause.  And  of  course  from 
this  rule  would  arise  the  same  canons  of  treatment, 
the  practical  conclusions,  the  things  we  care  most 
about,  the  canons  which  have  already  been  stated. 
The  results  of  experimental  evidence  will  harmonise 


186 

with  and  corroborate  the  conclusions  of  natural 
evidence,  but  both  are  really  experimental  if 
properly  viewed. 

But  we  may  go  a  great  deal  further  than  this. 
Not  only  is  constipation  induced  by  two  opposite 
sets  of  causes  by  too  little  and  by  too  much ;  so 
are  all  conditions  in  which  functions  come  to 
be  in  abeyance.  Mark  Twain  tells  us  how  the 
captain  in  charge  of  the  boat  for  those  43  days  did 
not  sleep  for  21  days  and  nights.  In  fact,  through 
direct  starvation,  he  lost  the  power  to  sleep.  But 
how  unwise  to  conclude  from  this  natural 
experiment,  so  to  call  it,  that  the  commonest  way 
in  which  sleeplessness  or  insomnia  is  brought  about 
is  by  taking  too  little  food,  and  taking  it  too 
seldom.  The  commonest  form  of  insomnia  is,  on 
the  other  hand,  caused  by  taking  food  too  often 
and  too  much.  The  explanation  of  the  modus 
operandi^  in  which  the  same  result  (I  use 
opposite  in  the  sense  of  contrary^  not  of  con- 
tradictory, i.e.,  as  marking  differences  of  quantity 
and  frequency,  as  to  more  or  less,  but  not  as 
marking  differences  as  to  kind  or  essence — which 
would  be  termed  contradictory.  Day  and  night, 
heat  and  cold,  e.g.,  are  contraries  of  one  another, 
but  motion  and  rest — if  there  is  such  a  thing  as 
absolute  rest — would  be  contradictories),  is  brought 
about  by  these  two  opposite  conditions,  may  be 
difficult,  and  different  opinions  may  be  held  about 
it.  I  think  the  explanation  is  the  following,  and 
that  it  is  the  same  in  principle  as  the  explanation 


187 

already  given  of  the  induction  of  constipation  by 
the  two  opposite  causes  of  too  much  and  too  little. 
In  order  that  sleep  may  be  induced  the  circulation 
of  the  blood  (and  of  the  lymph)  in  the  brain  must 
be  moderate  and  proportional.  But  the  function  of 
food  is  to  make  blood  and  lymph,  and  through 
proper  stimulus  of  nerves  to  control  their  cir- 
culation. When  men  are  directly  starved  for  many 
days,  so  that  they  threaten  to  die  from  direct 
starvation,  they,  of  course,  use  up  the  nutritive 
powers  of  their  blood.  Blood  too  poor  in  nutritive 
materials  is  sent  again  and  again  to  the  brain  and 
other  organs.  In  normal  circumstances  this  blood 
stimulates  the  coats  of  the  arteries  to  contract  and 
help  in  assisting  the  passage  of  the  blood  along  the 
arteries,  and  also  keeps  these  coats  in  proper  tone. 
In  normal  circumstances,  it  seems  to  me,  that 
through  the  action  of  the  trophic  or  vasomotor 
nerves  the  normal  tone  is  maintained  in  these  coats, 
as  also  a  normal  proportion  between  the  action  of 
the  longitudinal  and  the  transverse  or  circular  coats 
of  the  arteries.  In  health  I  think  the  arteries  are 
contracted  in  sleep,  while  the  veins  are  dilated ;  but 
contraction  is  kept  up  by  over-stimulation  of  the 
circular  coats  as  compared  with  the  longitudinal 
coats.  Normally  I  think  healthy  balance  between 
these  two,  results  in  rather  more  stimulation  of 
transverse  than  of  longitudinal  elements.  *     It  may 

•  The  same  relation  obtaining  between  the  longitudinal  and  transverse 
muscular  fibres  of  the  bladder  and  bowels  respectively,  leads  to  the 
prevention  of  unpleasant  accidents  in  their  corresponding  functions. 


188 

possibly  be  that,  while  both  the  longitudinal  and 

the   transverse   elements  are  under  the  control  of 

the  nervous  system,  the  transverse  coats  are  rather 

under   the   control   of    the  sjnnpathetic   system  of 

nerves,   while    the   longitudinal    are    rather   under 

the  government  of  the   cerebro-spinal  system.     If 

so,  this  would  account  for  the  well-known  fact  that 

too  much  excitement  or  too  much  anxiety  causes  a 

feeling   of    throbbing   in    the   head,    and   prevents 

sleep.     By  the  suggestion  made,  or   in  accordance 

with  it;  excitement,  and  anxiety,  and  mentalisation, 

or  cerebration  in  general,  tend  rather  to  stimulate 

the  longitudinal   elements  of  arteries,  and  so,  by 

contracting  them,  to  shorten  and  widen  or  dilate 

the  vessels,  and  so,  by  over  filling  them  with  blood, 

and   hence   by  supplying    too  much   blood   to   the 

brain  to  keep  it  awake,  and  prevent   sleep.     Too 

much  food  often  has  the  same  effect,     If  the  effects 

of  over  feeding  continue,  a  compensatory  action  is 

set  up,  and  the  transverse  coats  of  vessels  increase 

in   size    or   they    hypethoply,    as    if    in    order   to 

overcome     the    overplus    of    stimulation     of    the 

longitudinal   elements.     And,    in   fact,    we  find   in 

gout  and  other  states  of  over  feeding,  great  increase 

in   these  circular  or   transverse  coats,    so   that,    in 

some  cases,  they  contract  so  tightly  as  scarcely  to 

allow  the  blood  to  pass  at  all.     In  this  case  their 

action  must  be  to  induce  a  sort  of   obstipation  or 

constipation    of    the    brain    vessels,    just    as    the 

corresponding  state  already  referred  to  in  the  bowel 

narrows  its  lumen  so  much  as  to  allow  nothing   or 


189 

hardly  anything  to  pass,  and  so  to  cause  con- 
stipation of  the  bowels  from  excess  of  food.  But 
in  the  opposite  condition,  that  of  direct  starvation, 
acting  for  a  very  long  time,  the  blood  has  parted 
with  so  much  of  its  nutrient  material  that  it  cannot 
stimulate  the  coats  to  act  at  all ;  and  so,  as  in  the 
analogous  case  in  the  bowel,  whereas  we  saw  there 
was  nothing  to  pass,  and  no  strength  to  void  it  if 
there  had  been,  in  this  case  the  powers  of  the  brain 
and  nervous  system  are  so  weak  through  the 
impoverishment  of  the  blood  supply  that  the 
nervous  system  is  unable  to  sleep.  Here  is, 
therefore,  another  function,  that  of  sleep,  which 
disappears  under  starvation,  and  disappears  also 
under  the  long  continued  action  of  too  much  food, 
and  this,  be  it  observed,  even  if  the  explanation  I 
have  suggested  of  the  modus  operandi  is  incorrect. 
In  any  case,  the  practical  conclusion  that  we 
come  to  is  that  the  ordinary  form  of  insomnia 
ought  to  be  treated  by  cautious  restriction  of  the 
diet.  If  a  man  is  sleepless  on  four  meals  a  day,  let 
him  try  three  for  a  while  ;  if  this  is  insufficient  to 
make  him  sleep,  let  him  take  two ;  or,  if  two  are 
still  too  many,  let  him  try  one  daily  meal.  But  as 
we  cannot  wait  so  easily  for  the  arrival  of  sleep  as 
we  can  for  the  action  of  the  bowels  in  prolonged 
constipation,  an  admirable  device  for  procuring 
sleep  is  often  found  to  be  either  starvation  or  a  very 
restricted  diet,  a  glass  of  milk,  e.g.,  morning  and 
evening,  or  a  cup  of  cocoa  made  with  milk,  with  a 
basin  of  soup  with,  say,  a   slice   of  bread,  in  the 


190 

middle  of  the  day.  This  diet  is  in  most  cases 
effective  in  inducing  sleep  in  ten,  or  twelve,  or 
fourteen,  or  twenty  days.  If  at  the  commencement 
of  treatment  we  think  it  right  to  administer  a 
sleeping  draught  once  or  twice,  it  is  only  in  order 
that  we  may  be  able  soon  to  cease  its  administra- 
tion ;  for,  bad  as  are  the  effects  of  administering 
purgatives  to  cure  obstinate  constipation,  much 
more  damaging  and  much  more  to  be  deprecated  is 
the  too  common  practice  of  attempting  to  procure 
sleep  by  means  of  frequently  repeating  the 
administration  of  hypnotics.  I  hope,  in  fact,  that 
the  reader  is  beginning  to  be  prepared  for  the 
statement  that  he  is  a  poor  physician  (whatever 
be  his  legalised  medical  qualifications)  who  shall 
attempt  to  cure  constipation  by  purgatives  and  sleep- 
lessness by  the  administration  of  hypnotics.  But 
not  only  so ;  I  hope  he  will  be  beginning  to  see  that 
the  statement  may  be  generalised,  and  that  he  will 
perceive  how  poor  is  that  form  of  medical  practice 
in  general  which  shall  attempt  to  combat  any 
long  -  continued  condition  in  the  body  by  the 
administration  of  remedies  calculated  to  induce 
the  opposite  state — which  shall  attempt,  e.g.,  to 
cure  long  -  continued  diarrhoea  by  administering 
astringents,  lowness  or  depression  by  administer- 
ing stimulants,  and  stimulation  or  excitement  by 
depressants,  excess  of  acidity  by  the  administra- 
tion of  alkalies,  or  excess  of  alkalinity  by  the 
administration  of  acids.  These  conditions  may 
possibly  be  combatable  in  this  way  if  they  are  not 


191 

of  long  standing,  for  the  sufficient  reason  that  in 
this  case  they  tend  to  get  well  of  themselves,  and 
even  without  treatment ;  but  if  they  have  existed 
for  some  time,  such  treatment  is  quite  faulty,  and 
persistence  in  it  cannot  eventuate  in  the  cure  of  the 
patient,  unless  the  causes  of  the  irritation  are  also 
at  the  same  time  reduced,  the  usual  translation  of 
which  is  that  the  diet  ought  to  be  restricted.  Of 
course,  if  the  irritant  were  lying  in  the  digestive 
tract,  administering  a  purgative  might  succeed  in 
removing  it ;  but  if  it  were  in  the  blood,  no  such 
means  could  succeed  in  doing  so.  Hence  the  futility 
of  administering  purgatives  even  where  patients 
are  plainly  and  avowedly  suffering  from  the  long 
continued  effects  of  over -feeding.  A  purgative 
cannot  remove  the  cause  from  the  blood,  though 
it  may  succeed  in  doing  so  in  the  case  where  some 
irritating  material  is  lying  in  the  stomach  or 
intestines.  The  same  indeed  is  true  of  blood-letting, 
for  which,  however,  there  is  really  something  more 
to  be  said,  for  bleeding,  while  it  may  succeed  in 
removing  a  portion  of  the  materies  morbi  in  the 
blood,  can,  after  all,  remove  only  say  half  a  pint  or  a 
pint  of  blood,  while  the  quality  of  the  blood  which 
remains  is  unaltered,  and  must  continue  to  exert  its 
deleterious  influence  on  the  economy  ;  and,  if  the 
over-feeding  which  led  to  the  blood  containing  too 
much  nutrient  material  in  it  is  continued  after  the 
bleeding,  what  can  we  expect  except  that  the 
continuance  of  the  causes  will  re-induce  the  old 
effects?     For   this   reason,  among  others,  bleeding 


192 

has  been  practically  given  up  by  medical  men.  Let 
us  hope  that  we  shall  soon  see  the  evil  effects  of 
purgatives  and  hypnotics  as  clearly.  While  insomnia 
due  to  over-feeding  must,  therefore,  be  treated  by 
restriction  of  the  diet,  that  form  which  is  due  to 
direct  starvation,  the  form  from  which  Mark  Twain's 
men  were  suffering,  must  be  treated  by  cautious 
feeding  and  cautious  increase  of  the  diet. 

The  ancient  writers  on  medicine  used  to  say 
that  diseases  were  hot  and  cold  or  moist  and  diy, 
and  that  the  indication  for  treatment  was,  therefore, 
to  oppose  dry  by  moist  and  moist  by  dry,  to  oppose 
hot  by  cold  and  cold  by  hot.  Stated  in  these  ways 
these  terms  seem  fanciful,  as,  in  fact,  frequently 
was  the  treatment  adopted  in  conformity  with 
them,  remedies  being  likewise  divided  into  dry  and 
moist  and  hot  and  cold.  But  if  we  translate  these 
terms  into  the  scientific  language  of  to-day,  we 
shall  see  that  they  were  perhaps  not  so  fanciful  as 
we  had  supposed,  or,  at  least,  that  solid  facts 
underlay  them.  For,  undoubtedly,  in  some  diseased 
conditions,  although  the  ancient  physicians  could 
not  measure  it,  the  temperature  of  the  body  is  too 
high,  and  in  others  it  is  too  low,  and  the  physician 
often  enough  attempts  to  diminish  too  high  a 
temperature,  say,  by  putting  an  evaporating  or 
cooling  application  on  the  head,  or  even  by 
administering  (though  this  is  generally  not  so  wise 
a  measure)  a  remedy  whose  effect  is  to  lower 
temperature.  To  elevate  too  low  a  temperatm*e, 
which  is  almost  always  caused  by  too  much  food,  is  a 


193 

much  more  difficult  thing,  and  to  attempt  to  do  this 
by  stimulants,  for  example,  is  to  end  in  failure,  the 
only  sound  methods  of  doing  so  being  through 
restriction  of  the  diet  and  by  recommending 
exercises  with  or  without  the  use  of  baths.  But 
reflection  shews  that  though  it  might  have  been 
fanciful  to  speak  of  hot  and  cold  diseases,  it  is  not 
at  all  so,  but  is,  on  the  contrary,  highly  practical  to 
speak  of  those  with  a  temperature  above  natural 
and  those  with  too  low  a  temperature.  Likewise, 
moist  and  dry  in  disease  are  often  described  nowadays 
by  the  words,  too  dry  and  burning  a  skin,  or  one 
too  moist  and  sweating ;  and  physicians  to-day 
frequently  recommend,  at  least,  as  temporary 
measures  of  treatment,  sudorifics,  e.g.,  to  make 
the  skin  act ;  or  they  recommend  the  body  to  be 
sponged  over  with  say  tepid  applications  of  weak 
vinegar  solutions  to  check  sweating ;  or  even 
administer  remedies  with  that  intention.  Of  course 
it  is  much  sounder  and  better  practice  to  inquire 
what  made  the  temperature  too  high  or  too  low, 
what  made  the  skin  too  dry  or  too  moist,  and  to 
take  remedial  measures  in  accordance  with  our 
conclusions,  than  to  rest  contented  with  opposing 
moist  by  dry,  or  hot  by  cold. 

These  reflections  have,  however,  brought  us  in 
sight  of  our  second  great  paradox  in  medicine, 
which  is  that  the  same  causes  often  induce  opposite 
states  in  the  body.  The  first,  of  course,  was  that 
opposite  causes  induce  the  same  state.  Under  the 
second   paradox   we   find   statements  of  this  sort  : 

M 


194 

the  causes  of  constipation  and  of  diarrhoea  are 
often  the  same,  viz.,  excess  of  stimulus,  the  chief 
form  of  which  is  excess  of  food.  The  causes  of 
feverishness  or  elevation  of  temperature,  and  of 
depression  with  too  low  a  temperature,  are  often 
the  same,  viz.,  wrong  food  habits;  so  with  the 
causes  of  too  great  dryness  and  of  too  great 
moisture  of  the  skin ;  so  with  the  causes  of  too 
heavy  sleep  and  too  little  sleep — they  are  often  the 
same.  And  of  course  it  follows,  if  this  is  so,  that 
the  treatment  of  these  various  and  opposite 
conditions  must  frequently  be  the  same,  the  great 
remedy  being  restriction  of  the  diet.  Much  con- 
sideration and  much  patience  is  required  before 
assent  is  given  to  this  general  proposition  that  the 
correct  treatment  of  opposite  states  is  the  same. 
At  first  sight,  in  fact,  it  seems  impossible  that  it 
can  be  true.  To  recommend  an  obese  person  to 
restrict  his  diet  or  his  drink  may  seem  quite 
rational  and  in  accordance  with  common  sense  and 
common  experience.  But  to  say  to  a  thin,  wasted, 
weak  and  attenuated  person,  "  you  must  restrict 
your  diet  in  order  to  get  rid  of  your  thinness,  your 
wasting,  your  attenuation,  your  weakness ; "  this, 
it  must  be  admitted,  does  sound  foolish  and 
unnatural.  Nevertheless,  it  is  so  often  true,  and  so 
often  helpful  to  the  patient  to  offer  him  this 
seemingly  parodoxical  advice,  that  we  must  consider 
and  patiently  discuss  it  for  a  while,  because 
unquestionably,  he  who  does  not  understand  it  can 
have    no    correct   view    of     medicine   and   medical 


195 

practice,  and  will,  in  consequence,  fail  to  cure  a 
large  proportion  of  patients,  whose  ailments, 
nevertheless,  are  curable  if  the  treatment  is 
properly  set  about.  But  we  shall  find,  if  we  allow 
ourselves  to  observe  a  little,  and  to  reflect  on  what 
we  do  observe,  much  corroboration  of  this  view. 
Breeders  of  fowls,  for  example,  and  fatteners  of 
fowls  for  the  market  know  that  if  animals  are  over- 
fed they  become  thin  and  wasted,  and  fall  off  in 
weight.  The  mode  in  which  Sussex  and  Surrey 
fowls  are  fattened  for  market  is  said  to  be  the 
following.  For  about  a  fortnight  they  are  confined 
in  coops  and  suppHed  with  as  much  corn  as  they 
can  eat.  After  about  that  length  of  time,  their 
appetite  falls  off,  whereupon,  for  another  fortnight 
or  so,  they  are  artificially  fed  with  soft  food,  inserted 
into  their  gizzards  with  a  squirt  several  times  a  day. 
They  have  then  reached  their  highest  weight,  and 
it  is  found  that  they  must  then  be  sent  to  market, 
if  the  owners  are  to  make  the  best  profit  out  of 
them,  because,  if  they  are  not,  they  then,  or  soon, 
begin  to  fall  off  in  weight,  to  become  thin  and 
attenuated  from  over-feeding.  The  first  effect  of 
over-feeding  is  greatly  to  increase  the  weight,  but 
the  second  as  markedly  to  diminish  it.  The  same 
cause,  viz.,  over-feeding,  does  induce  opposite  states, 
viz.,  too  great  stoutness  and  too  great  thinness. 
The  thinness  which  follows  over-feeding  was  called 
by  Dr.  King  Chambers  the  starvation  of  over- 
repletion.  It  is  quite  evident  that  a  sound  way  to 
overcome  it  is  and  often  must  be  to  restrict  the  diet. 

M  2 


196 

But  it  is  not  difficult  to  see  how  this  may  be  so, 
because,  in  fact,  people  themselves  will  often  come 
to  doctors  with  the  statement  :  "  My  food  does  not 
seem  to  be  doing  me  any  good,  doctor."  And  the 
doctor  has  frequently  to  reply,  "  You  will  get  more 
benefit  out  of  it  if  you  take  less  of  it."  No  doubt 
this  state  of  thinness  and  wasting  is  often  treated 
by  over-feeding,  and  apparently  with  good  results, 
at  least  for  a  time,  patients  improving  very  much 
under  seclusion  and  over-feeding,  as  it  is  called. 
But  do  not  let  us  be  led  away  by  words.  Let  us 
see  what  this  diet  by  "  over-feeding "  really  is. 
Here  is  an  account  of  the  diet  of  one  of  these  cases, 
variously  termed  hysteria,  neurasthenia  and  anaemia, 
in  which  patients  are  thin,  low  and  weak,  and  in 
which  they  are  treated  by  over-feeding. 

"  Patient  kept  in  bed  ;  rising  only  to  relieve 
calls  of  nature. 

"  First  day  :  one  quart  of  milk  in  divided 
doses  every  three  hours. 

"  Second  day  :  cup  of  coffee  on  awakening. 
Two  quarts  of  milk  in  divided  doses  every  two 
hours.     Aloetic  pill  at  night. 

"  Third  to  sixth  day  :  same  diet. 
"  Seventh,   eight   and  ninth  days  :   same    diet, 
with  a  pint  of  raw  soup  in  three  portions  (the  soup 
is  made  by  treating  raw  beef  with  strong  hydro- 
chloric acid). 

"  Tenth  day  :  7  a.m.,  coffee;  7-30  a.m.,  half  a 
pint  of  milk  ;  10  a.m.,  12  noon,  2,  4,  6,  and  10  p.m., 
ditto;  soup  at  11  a.m.,  5  and  9  p.m. 


197 

"  Fourteenth  day :    egg  and  bread  and  butter 
added. 

"Sixteenth  day  :  dmner  added  and  iron." 
But  in  what  sense  is  this  diet  a  generous  diet  ? 
It  is  not  generous  at  all.  It  is  a  spare  diet,  yes, 
and  a  very  spare  diet.  A  quart  of  milk  in  the  first 
24  hours,  and  nothing  else,  surely  that  is  a  very 
restricted  diet.  In  calories,  it  comes  to  about  600, 
while  the  fasting  man,  as  we  shall  see  in  Chap.  VIII., 
on  the  authority  of  a  distinguished  physiologist, 
requires,  or  at  least  produces,  2303  calories.  But 
the  first  day  is  only  the  introduction.  Let  us  see 
the  next  stage.  From  the  second  to  the  sixth  days 
double  this  quantity  of  milk  was  administered,  and 
nothing  else.  But  1200  calories,  the  amount  of 
energy  obtainable  from  this  diet,  is  yet  only  a  little 
more  than  half  of  that  given  out  by  the  starving 
man,  and  about  half  of  that  emitted  by  the  physician 
or  the  ofiicial,  as  we  shall  see  in  due  time.  Up 
to  the  present  point,  therefore,  this  diet  of  over- 
feeding is  only  about  half  of  a  starvation  diet. 
From  the  seventh  to  the  ninth  days  a  pint  of  raw 
soup  was  added,  i.e.,  a  pint  of  soup  into  which  the 
juice  of  a  pound  of  raw  beef  had  been  strained.  This 
would  not  and  did  not  contain  much  of  the  nutritive 
matter  of  the  beef,  but  if  we  were  to  admit  that  it 
contained  all  the  nutritive  value  of  a  pound  of 
beef,  and  were  to  add  1000  calories  as  representing 
the  energy  value,  we  should  still  find  that  our 
so-called  over-feeding  diet  amounted  to  only  2200 
calories  of  energy  value,  which  is  even  yet  less  than 


198 

the  amount  demanded  by  the  starving  man.  But 
it  would  be  a  gross  exaggeration  to  suppose  or 
estimate  that  a  pint  of  raw  soup,  made  in  the  way 
described,  contained  an3rthing  near  1000  calories. 
I  really  think  that  100  calories  would  be  nearer  the 
energy  value  of  a  pint  of  raw  soup  made  in  this 
way.  We  come,  therefore,  after  what  I  think  is  a 
very  fair  and  quite  impartial  examination  of  a  diet 
of  "  over-feeding,"  to  the  conclusion  that  for  the 
first  fortnight  it  is  a  diet  of  restriction,  and  even  of 
great  restriction.  I  quite  agree,  nay,  I  strenuously 
assert  that  the  principle  of  treatment  by  restriction 
is  correct ;  but  one  must  emphatically  protest  against 
its  being  called  a  generous  diet  or  a  diet  of  over- 
feeding. The  patient's  body  is  being  called  upon 
during  that  fortnight  to  part  with  its  surplus 
stores,  those  surplus  stores  which  made  the  patient 
weak,  thin  and  attenuated,  because  they  were  in 
excess.  This  will  be  appreciated  better  if  it  is 
realised  that  the  urine  passed  in  these  circumstances 
has  often  a  specific  gravity  as  high  as  1030  in  place 
of  1010.  A  most  excellent  canon  of  treatment,  in 
fact,  for  these  cases  is  to  go  on  with  the  greatly 
restricted  diet  until  the  specific  gravity  of  the  urine 
falls  to  1010,  after  which  cautious  increase  of  the 
diet  may  be  ordered,  especially  if  in  the  meantime 
the  very  low  bodily  temperature  generally  found  in 
these  cases  has  shewn  signs  of  rising.  In  four  to 
six  weeks  or  so  in  my  experience,  these  two  facts 
begin  to  shew,  when  I  generally  get  patients  on  to 
one  solid  meal  a  day,   and  continue  that  for  some 


199 

time,  and  uDtil  they  are  ready  for  more,  and  until 
they  demand  more. 

But  let  us  pursue  the  account  of  the  over- 
feeding diet,  which,  for  the  first  fortnight,  is,  as  we 
have  seen,  a  diet  of  starvation. 

"  Nineteenth  day :  The  entire  diet  was  as 
follows  : — 7-0  a.m.,  coffee.  8-0  a.m.,  iron  and  malt 
extract ;  breakfast,  consisting  of  a  chop,  bread  and 
butter,  a  tumblerful  and  a  half  of  milk.  11-0  a.m., 
soup.  2-0  p.m.,  iron  and  malt  ;  dinner  of  anything 
liked,  with  six  ounces  of  Burgundy  or  dry 
champagne,  and  at  end  one  or  two  tumblers  of 
milk.  4-0  p.m.,  soup.  7-0  p.m.,  malt  iron,  bread 
and  butter,  usually  some  fruit,  and  two  glasses  of 
milk.  9-0  p.m.,  soup.  10-0  p.m.,  aloetic  pill."  I 
have  had  some  lifl&culty  in  calculating  the  calorie 
value  of  this  diet.  I  am  sure  it  is  too  much,  and 
that  after  the  patient  had  been  on  so  restricted  a 
diet  for  the  first  fortnight  it  would  have  been  better 
to  go  on  as  on  the  sixteenth  day,  with  dinner  added 
to  the  starvation  diet,  when  the  patient  would  have 
had  sufficient  food,  and  would  not  have  required  the 
aloetic  pill  at  bed  time.  On  a  sufficient  diet, 
neither  too  much  nor  too  little,  the  bowels  regulate 
themselves,  and  no  aperients  are  required.  If,  on 
the  other  hand,  aperients  are  required,  we  may 
be  sure  that  the  food  administered  is  either  too 
much  or  too  little.  So  far,  however,  as  I  can  make 
out,  the  diet  represents  about  3445  grand  calories  in 
value,  made  up  as  follows.  The  bread  given  is  not 
quantified,  but  I  have  assumed  that   4  ozs.   were 


200 

given  at  8-0  a.m.  and  7-0  p.m.,  and  2  ozs.  at  dinner, 
that  is,  10  ozs.  in  all.  This  is  more,  let  me  say 
here,  than  the  average  woman  can  continue  to  take 
without  getting  indigestion,  colds,  rheumatism,  &c. 
She  may  of  course,  however,  take  this  amount  daily 
for  some  time  without  suffering  in  these  ways,  for  as 
long  perhaps  as  the  "  over-feeding "  diet  lasts, 
though  what  a  misnomer  "  over-feeding  "  is  in  the 
first  fortnight  of  the  diet  we  have  seen. 

7-0  a.m.,  cup  of  coffee.  There  is  no  calorie 
value  in  this,  or  almost  none.  Its  use  in  the  body 
is,  however,  great,  as  it  stimulates  the  body  to  draw 
on  its  own  reserves  and  to  use  up  some  of  them. 
The  increase  of  temperature  which  generally  follows 
the  administration  of  a  cup  of  hot  coffee  is  a  proof 
of  this.  I  have  known  the  temperature  of  the 
body  to  be  raised  by  one  or  two  degrees  F.  for  an 
hour  or  longer  by  such  a  dose  of  coffee.  Half  a 
pound  or  half  a  pint  of  hot  coffee  solution  at 
110°  F.  could  not  possibly  raise  the  temperature  of 
a  woman  weighing  about  100  lbs.,  through  one  or 
two  degrees  F.  in  temperature.  It  is  a  physical  and 
mechanical  impossibility.  But  it  may  and  easily 
does  so  by  stimulating  the  body  to  oxidise  some 
of  its  own  surplus  stores  lying  unused,  and  to  some 
extent  clogging  the  body ;  and  so  it  performs  a 
very  useful  part  in  the  economy. 

8-0  a.m.,  breakfast.  4  ozs.  of  bread  =  276 
calories,  and  4  ozs.  of  chops  uncooked  =  3  ozs. 
cooked  =  say  120  calories,  and  milk  =  225  calories, 
butter,  1  oz.   =  208  calories. 


201 

11-0  a.m.,  soup.  This  contains  little  or  no 
calorie  value,  acting  in  much  the  same  way  as  the 
hot  coffee  does,  and  stimulating  the  better  digestion 
of  the  breakfast  so  as  to  prepare  the  stomach  for 
dinner  at  two.  But  let  us  say  that  half  a  pint  of 
soup  contains  65  calories  (perhaps  50  calories  would 
be  nearer  the  mark). 

2-0  p.m.,  ordinary  dinner.  Suppose  this  to 
weigh  two  to  two  and  a  half  pounds  of  mixed  diet 
as  it  comes  to  the  table,  made  up  say  of  4  ozs.  of 
meat  =  196  calories;  2  oz.  of  bread  =138  calories ; 
}  lb.  of  potatoes  =  270  calories ;  cooked  fruit,  1  lb. 
calorie  value,  say  200  calories ;  1  oz.  of  cheese 
=  125  calories  ;  1  oz.  of  butter  =  208  calories;  two 
tumbler sful  of  milk  =  300  calories. 

4-0  p.m.,  soup  =  65  calories. 

7-0  p.m.,  bread,  4  ozs.  =  276  calories  ;  butter, 
1  oz.  =  208  calories  ;  fruit,  say  200  calories  ;  two 
glasses  of  milk  =  300  calories. 

9-0  p.m.,  soup  =  65  calories. 

The  total  estimated  calorie  value  of  this  diet 
comes  therefore  to  about  3445  calories.  I  have  not 
been  able  to  do  more  than  guess  at  the  calorie 
value  of  the  fruit,  which,  it  is  well  known  as  to 
many  kinds  of  it,  consists  of  about  90  per  cent,  of 
water ;  but  I  have  estimated  the  calorie  value  of  a 
pound  of  it  as  about  equal  to  3  ozs.  of  bread. 
This  specimen  of  diet  of  over-feeding,  taken  from 
Professor  Davis's  Dietotherapy,  can  scarcely  be 
termed  a  very  excessive  diet,  representing  in  calorie 
value  barely  more  than  half  as  much  again  as  the 


202 

energy  lost  daily  by  the  starving  man,  but  with 
the  patient  in  bed  is  probably  a  good  deal  more 
than  was  required.  For  one  thing,  the  need  for 
administering  an  aperient  at  bed  time  is  itself  a 
suggestion  in  this  sense.  But  this  specimen  of  a 
diet  of  over-feeding  is  much  less  than  is  administered 
in  some  cases  in  which  patients  are  heavily  fed 
every  two  or  three  hours  during  the  day,  and  in 
which  much  larger  quantities  of  food,  representing 
a  much  higher  and,  it  must  be  held,  quite  un- 
necessary and  very  undesirable  quantity  of  calorie 
value,  are  given.  Even  if  apparently  well  borne  at 
the  time  (but  many  patients  rebel  greatly  when 
undergoing  the  treatment),  it  is  difficult  to  avoid 
the  conclusion  that  later  it  must  lead  to  the 
occurrence  of  gout,  rheumatism,  colds,  headaches, 
or  other  ailments  in  patients  so  treated,  especially 
as  the  treatment  itself  offers  a  tacit  suggestion  that 
the  patient  should  go  on  afterwards  living  more  or 
less  under  the  idea  that  heavy  feeding  is  a  main 
means  towards  maintenance  of  health  and  strength. 
The  explanation  of  the  high  specific  gravity  of 
the  urine  formerly  referred  to  is  simple,  on  the 
theory  that  the  body  and  its  circulation,  the  blood 
and  the  lymph  spaces,  are  loaded  with  unused 
material  accumulated  within  them,  and  on  the  view 
that,  under  restriction  of  the  diet,  the  body  begins 
to  use  them  up,  and  to  eliminate  them ;  but  it  is 
difficult  to  explain  it  on  any  other  theory.  In  fact, 
if  we  examine  we  shall  find  that  the  urine  passed 
by   persons   in  the    state   of   neurasthenia,   ovarian 


203 

neuralgia,  hysteria,  general  debility,  and  wasting 
without  feverishness,  for  the  treatment  of  which 
recourse  is  generally  had  to  what  is  called  over- 
feeding, differs  from  time  to  time  very  much  in 
specific  gravity.  Sometimes  a  large  quantity  of 
urine  looking  very  much  like  pure  water  is  passed. 
This,  on  examination,  proves  to  have  a  very  low 
specific  gravity,  say  of  1004  or  1006,  and  to 
contain  very  few  chemical  salts.  At  other  times, 
and  more  often,  the  urine  is  found  to  be  of  the 
high  specific  gravity  of  1030  or  1032,  formerly 
described.  When  this  occurs  under  restriction  of 
diet,  and  before  over  -  feeding  is  commenced,  a 
possible  explanation  might  be  that  the  body  is 
living  on  itself,  that  it  is  using  up  its  own  materials, 
and  that  the  high  specific  gravity  is  caused  by  the 
presence  in  the  urine  of  the  products  of  the 
oxidation  of  the  tissues  of  the  body.  If  this  were 
so,  however,  to  any  great  extent,  feverishness,  or 
elevation  of  temperature,  with  quickening  of  pulse, 
might  be  expected  to  be  present.  As  a  rule, 
however,  neither  of  these  conditions  is  present,  the 
temperature  being  generally  considerably  too  low 
(96°  or  97°  F.,  e.g.,  in  place  of  98-4°  R),  while  the 
pulse  is  not  quickened.  Still,  the  body  must  to 
some  extent  be  considered  to  be  living  on  itself 
during  the  treatment,  because,  during  restriction,  it 
is  not  being  suppHed,  as  we  have  seen,  with  sufficient 
food  for  the  long  continued  maintenance  of  life  ;  and 
we  are  corroborated  in  this  view  by  the  fact,  fre- 
quently observed,  that  women  treated  in  this  way 


204 

may  increase  their  weight  at  the  same  time  that 
their  food  is  diminished.  This  has  occurred  frequently 
in  my  practice,  and,  among  other  cases,  in  that  of  a 
young  woman,  twenty-six  years  of  age,  who  had 
been  ill  for  three  years  with  dyspepsia  and  anaemia, 
and  had  been  unable  to  follow  her  occupation  for 
two  years.  For  the  first  four  weeks  of  treatment 
she  took  a  tumblerful  of  milk  mixed  with  an  equal 
quantity  of  boiling  water  morning  and  evening,  and 
about  half  a  pint  of  mutton  -  or  chicken  -  soup  in 
the  middle  of  the  day,  and  nothing  else.  She  was 
not  confined  to  bed,  but  went  about  all  the  time. 
For  the  next  five  weeks  she  had  the  same  allowance 
of  milk  morning  and  evening,  or  she  took  hot  barley 
water  in  place  of  the  hot  water.  For  dinner  she 
had  half  a  pint  of  any  soup  with  some  green 
vegetables  in  it,  well  cooked,  as  sprouts,  cauliflower, 
or  celery,  or  cucumber,  and  some  Parmesan  cheese 
dredged  over  it.  The  solid  constituents  of  her  diet 
did  not  weigh  more  than  eight  ounces,  and  green 
vegetables  contain,  it  is  well  known,  about  90  per 
cent,  of  water  in  their  composition.  Nevertheless, 
on  this  diet,  she  got  entirely  rid  of  her  dyspepsia, 
no  longer  vomited  the  bitter  stuff  she  formerly  did, 
and,  to  a  great  extent,  got  rid  of  her  anaemia  ;  her 
friends  complimenting  her  on  her  improved 
appearance.  More  strange  it  is  to  add  that  on  this 
diet  she  gained  one  and  a  half  pound  in  weight  in 
three  weeks.  No  doubt  she  drew  on  the  over- 
accumulation  of  reserves  in  her  body  for  some  of  the 
supplies  on  which  she  lived  during  the  time,   for  it 


205 

is  not  to  be  supposed  that  she  could  continue  to  live 
on  such  a  diet,  especially  after  she  shall  have 
returned  to  her  work.  And  the  waste,  effete, 
unused  material  accumulated  in  her  body,  and 
converted  under  this  regime  into  the  heat  and 
energy  of  life,  was  probably  replaced  by  water  in 
the  tissues,  so  that  she  gained  weight.  A  certain 
amount  of  this  replacement  by  water  was  no  doubt 
of  the  greatest  benefit  to  the  patient,  for  in  anaemia 
the  tissues  are  so  shrunk  and  "  constipated,"  or 
obstipated,  and  the  circulation  in  them  is  so  blocked, 
that  the  blood  cannot  enter  them  freely.  The 
oxidation  and  metabolism,  therefore,  that  ought  to 
occur  in  the  tissues  is  prevented  from  taking  place. 
This  leads  to  further  blocking  and  further 
obstipation,  especially  if  attempts  are  made  to 
"feed  up,"  as  they  so  frequently  are  in  this 
affection.  The  first  part  of  the  treatment  which 
goes  under  the  name  of  over-feeding  being, 
therefore,  a  restriction  of  the  diet,  so  that  the  body 
may  be  called  on  to  eliminate  the  excess  of  material 
accumulated  within  it,  the  next  part  of  the 
treatment  ought  to  consist  in  getting  the  body  on 
to  proper  nourishment,  and  this  the  treatment 
attempts  to  do.  Of  course  much  depends  on  the 
view  which  we  take  of  the  facts  before  us.  If  we 
think  that  the  lowness,  the  weakness,  the  thinness, 
and  the  low  temperature  are  marks  of  under- 
feeding, we  shall  order  a  course  of  gradually 
increased  feeding,  or  even,  perhaps,  for  a  time, 
of  over-feeding.     If,   on  the  other  hand,  we  think 


206 

these  are  the  sign  of  plugging,  blocking  and 
obstipation  of  the  fluids  and  tissues  of  the  body,  we 
shall  restrict  the  diet.  It  is  a  curious  thing  to  find 
that  the  first  fortnight  of  what  is  called  over-feeding 
is  really  a  diet  of  great  restriction.  But  whatever 
view  we  take  of  the  causation  of  the  patient's  state, 
there  is  certainly  a  danger  that  in  the  next  part  of 
the  treatment  the  administration  of  food  may  be 
carried  so  far  as  to  over-load  the  blood,  and  lymph, 
and  tissues  with  excess  of  the  products  of  digestion  ; 
and  it  is  to  me,  I  must  say,  more  than  doubtful 
whether  the  greatly  increased  diet  sometimes 
administered,  a  diet  much  heavier  than  the  one 
described  by  Professor  Davis,  is  either  necessary  or 
desirable.  It  seems  to  me  to  cause  loss  of  strength, 
plugging,  blocking,  constant  tendency  to  take 
colds,  headaches,  feeling  of  fatigue,  and  other 
ailments.  Some  patients  even  resent  it  while 
feeling  over-persuaded  to  submit  to  it ;  and  I  have 
heard  complaints  from  such  that  they  were  simply 
stufied  like  geese  that  are  being  prepared  for  the 
market. 

We  have  been  led  into  this  digression  through 
consideration  of  the  different  methods  of  treatment 
that  must  be  adopted  according  to  the  different 
points  of  view  from  which  we  see  the  facts  before 
us,  and  because  this  seemed  a  suitable  place  in 
which  to  discuss  the  treatment  of  over-feeding. 
We  must  now  proceed  to  discuss  further  the  aspects 
of  our  second  paradox  that  the  same  causes  induce 
or  cause  the  production   of  opposite  states  in  the 


207 

body.  This  academic  discussion  has  the  most 
important  practical  bearings,  as  we  have  seen.  It 
makes  to  the  patient  all  the  difference  between 
recovery  and  failure  to  recover,  between  life  and 
death,  what  view  we  take  of  his  ailment,  because 
on  the  view  we  take  depends  the  course  of  treat- 
ment which  we  recommend  for  him.  An  academic 
discussion,  therefore,  on  the  part  of  the  medical 
adviser  is  a  practical  matter  of  life  or  death  to 
the  patient.  If  the  medical  adviser  or  the  reader 
is  tempted  to  think,  he  will  steer  clear  of  the 
whole  discussion,  if  he  thinks  he  will  give  it 
the  go-bye,  if  love  of  peace  and  quiet  tempt 
him  to  withdraw  and  let  others  fight  it  out, 
he  must  be  reminded  that  peace  is  not  so  to  be 
obtained,  that  refusal  to  consider  a  question  does 
not  make  it  non-existent,  and  that  the  question  is 
a  clamant  one  and  of  the  most  supreme  importance, 
because  his  future  and  that  of  those  dependent 
on  him  is  bound  up  in  it.  He  simply  must  face  it, 
for  there  is  no  escape. 

It  is  difficult  to  find  the  best  way  of  putting 
the  results  of  the  second  medical  paradox.  Perhaps 
as  good  a  way  as  any  to  explain  how  constipation 
and  diarrhoea,  slow  pulse  and  quick  pulse,  depression 
and  fever,  melancholia  and  excitement,  with  a 
variety  of  other  opposite  conditions,  are  frequently 
produced  by  the  same  causes,  and  particularly  by 
excess  of  food,  is  by  stating  the  following  proposi- 
tion. ALL  AGENTS  WHICH  AFFECT  THE 
BODY   OK    ANY    PAKT    THEREOF    EXEET 


208 

ON  IT  A  TWO -FOLD  AND  CONTRARY 
ACTION  IN  TIME,  THE  SECONDARY  OR 
REACTIVE  ACTION  BEING  THE  OPPOSITE 
OF  THE  ACTIVE  OR  PRIMARY  ONE.    As  we 

have  seen,  there  are  only  two  fundamental  states  in 
the  body,  or  in  parts  thereof,  or  tissues  thereof,  viz. , 
shrinking  and  swelling,  contraction  and  dilatation, 
stricturn  et  laxmn,  as  the  Latins  called  them. 
The  Greek  medical  writers  knew  these  two  con- 
ditions under  many  and  varied  names,  as,  e.g., 
arovia  koX  poxji^  ;  crTeyvov  /cat  poiohe<; ;  crreyvwcrts 
KoX  pvcTLt; ;  TOLCTL'^  Kol  ^^aXacTts  ;  crvuaycoyyj  kol 
X^o"ts ;  KeKkeiOTfJiivov  koX  dvecoyjxeuov ;  TrvKvo)cn<;  kol 
dpaLO)(TL<S'  The  Latins,  again,  keeping,  in  accordance 
with  the  genius  of  their  race,  rather  to  the  simpler 
and  logical  division  of  strictmn  et  laxum,  than  to 
the  more  florid  and  more  imaginative  subtleties  of 
the  Greek  mind  ;  but  finding  that  discharges  (or  as 
we  should  now  term  them,  secretions  and  excretions, 
especially  the  latter)  are  given  out  from  the  body 
during  the  state  of  laxum.  or  dilatation,  unfor- 
tunately introduced  another  term,  viz.,  solidio,  as 
the  opposite  of  strictiira,  and  then  by  a  lapse  of  the 
logical  faculty  came  to  use  solutio  for  any  condition 
characterised  by  such  discharges  as  phlegm  in 
coughing,  or  diarrhoea  or  sweating,  instead  of  as  a 
name  for  the  dilatation  which  they  thought  to 
accompany  them.  By  opposing  strict ur a  to  solutio 
they  really  mixed  up  property  and  function,  since 
stricturn  et  laxum  are  fundamental  properties 
of    organised    (and   unorganised)    bodies,    while    of 


209 

strictura  et  solutio,  the  latter  at  least  denotes  a 
functional  change  occurring  in  an  organised  body, 
and,  as  such,  ought  to  have  been  opposed  not  to 
strictura  but  to  ahsorptio  or  imbibitio,  if  there  had 
been  such  a  word.  The  logical  and  word-saving 
Boman  became  confused  here,  but  he  was  right  to 
this  extent  that  in  solutio,  when  some  material  is 
being  expelled  from  the  body,  the  process  is  accom- 
panied, no  doubt,  by  dilatation  of  the  longitudinal 
elements  of  tissues,  but  is  effected  by  contraction 
{strictura)  of  the  transverse.  Absorptio,  on  the 
other  hand,  takes  place  only  when  contraction 
{strictura)  of  the  longitudinal  elements  occurs,  and 
this,  as  we  have  seen,  necessarily  leads  to  dilatation 
(laxatio)  of  the  transverse,  the  latter  action  causing 
opening  of  the  mouths  of  vessels,  by  which  alone 
absorption  is  possible.  In  strictum  of  the  transverse 
elements,  which  is,  of  course,  accompanied  by 
laxum  of  the  longitudinal,  organised  bodies,  having 
expelled  their  secretion  or  excretion,  become  dry ; 
while  in  strictum  of  the  longitudinal  elements, 
leading  necessarily  to  laxum  of  the  transverse, 
moisture  appears  in  organised  bodies.  Strictum  et 
laxum  therefore  are  the  physical  or  anatomical 
■changes  which  occur  in  tissues  ;  absorptio  et  solutio 
are  the  corresponding  functional  changes.  But  as 
the  ancients,  both  Greek  and  Latin,  had  not 
distinguished  either  between  structure  and  function 
on  the  one  hand,  or  between  the  necessarily  opposed 
states  of  contraction  of  longitudinal  and  transverse 
^elements  on  the  other,  and,  as  lastly  they  did  not 

N 


210 

clearly  see  that  strictum  of  elements  is  invariably 
in  time  followed  by  laxum  of  the  same  elements, 
their  thinking  on  the  subject  became  very  much 
confused.  For,  when  the  Latins  spoke  of  strictwce 
et  solutionis  co7nplexto  they  plainly  mixed  up 
contraction  of  longitudinal  and  contraction  of 
transverse ;  whereas,  had  they  used  the  term 
alternatioj  and  had  they  spoken  of  stncturcs  et 
solutionis  alternatio,  of  alternation  in  place  of 
combination  or  mixture,  they  would  have  kept  to 
simpler  considerations,  which  would  have  delivered 
them  and  their  followers  from  much  confusion. 
When,  however,  contraction  of  one  set  of  elements 
has  the  same  effect  as  dilatation  and  even  paralysis 
of  another,  things  do  become  very  complicated  and 
difficult  to  explain.  From  this  point  of  view  we 
may  perhaps  somewhat  understand  how  medical 
expert  A  advises  his  patient  in  a  sense  diametrically 
opposite  to  that  recommended  by  his  colleague  B, 
the  permutations  and  combinations  of  two  or  three 
pairs  of  opposite  things  being  almost  impossible  of 
comprehension  by  the  average  human  intellect. 
And  we  must  to  this  add  the  consideration  that  a 
vehement  desire  on  the  part  of  the  patient  to 
escape  from  his  misery,  and  a  failure  to  discover 
whether  the  misery  depends  on  excess  or  deficiency, 
or  rather  perhaps  the  conviction  that  it  does  depend 
on  too  little  and  not  on  too  much,  is  apt  to  force  the 
hand  of  the  medical  adviser  and  to  compel  him  to 
allow  indulgences  which  his  judgment  feels  are 
beyond  the  line  of  true  moderation.     Our  general 


211 

proposition,  therefore,  translates  itself  into  this,  that 
when  an  agent  primarily  shrinks  the  body  it 
secondarily  swells  it.  Cold  is  such  an  agent,  and 
the  effect  of  cold  is  such  that  while  its  primary 
action  is  to  shrink  the  tissues,  its  subsequent  action 
or  its  reaction  is  to  swell  them.  Shrinking,  there- 
fore, or  swelling,  may  either  of  them  be  the  effect 
of  cold.  Heat  also  first  contracts  and  secondly 
expands  the  body,  and  so  either  contraction  or 
swelling  may  be  the  efiect  of  heat.  Contraction 
of  transverse  elements  may  be  considered  as  the 
type  of  depressing  action  ;  their  dilatation,  on  the 
other  hand,  as  the  type  of  elevating  or  feverish 
action.  Tonics  usually  act  as  primary  shr inkers 
and  secondary  swellers.  Relaxants  usually  act  as 
primary  swellers  and  secondary  shrinkers.  Ex- 
posure to  cold  first  braces  up  to  action  and  then 
causes  swelling,  fatigue,  and  sleep — after  which  we 
are  ready  to  begin  again.  Alcohol,  on  the  other 
hand,  first  reddens  the  face,  relaxing  the  vessels, 
and  then  shrinks  them,  so  causing  pallor,  and,  if 
the  action  has  been  carried  far,  shrinking  secondarily 
the  vessels  of  the  brain  so  much  as  to  cause  a 
headache  in  the  morning.  As  a  small  quantity  of 
the  agent  which  in  excess  did  the  mischief,  and 
which  caused  the  headache  as  its  secondary  effect, 
relieves  the  headache  by  dilating  the  vessels  as  its 
renewed  primary  effect,  we  see  how  much  room 
there  is  for  difference  and  even  for  opposition  of 
practice,  and  perhaps  we  may  be  able  to  understand 
somewhat  the  reasons  for  the  existence  of  rival  schools 

N2 


212 

opposed  in  practice  to  one  another.  But  a  patient 
and  repeated  investigation  of  facts,  and  the  explana- 
tion of  the  same,  must  unquestionably  lead  to  greater 
toleration  by  rival  schools  of  the  methods  of  one 
another,  and  in  time,  perhaps,  to  better  agreement 
among  them  as  to  practice.  How  much  depends  on 
the  natural  action  of  nature,  and  how  much  is  to  be 
attributed  to  the  artificial  action  of  the  remedies 
administered,  ought  reasonably  to  be  considered  by 
both  sets  of  practitioners.  The  result  of  such 
inquiry,  and  of  others  like  it,  will  undoubtedly  be 
good  both  for  the  practitioners  and  for  those  on 
whom  they  practise.  Take  the  case  of  a  navvy 
working  in  a  sewer  with  his  feet  all  day  in  six 
inches  of  water,  perhaps  foul  water,  and  a  wind 
blowing  through  the  sewer.  The  man's  tissues  are 
shrunk  by  the  application  of  cold  and  by  the  loss  of 
heat  from  his  body.  He  shivers,  and  (especially 
when  there  is  much  effete  unused  stuff  in  his  body, 
that  is,  when,  as  is  mostly  the  case,  he  has  not 
assimilated  all  the  food  he  has  taken)  he  is  soon  found 
to  have  a  high  temperature  and  quickish  pulse,  and 
may  be  diagnosed  to  be  suffering  from  pneumonia 
or  inflammation  of  the  lungs.  Cold  was  the 
immediate  exciting  cause  of  this.  The  predisposing 
cause  was  the  state  of  the  man,  particularly  the 
relation  of  his  body  to  the  prolonged  influences  of 
its  food  environment.  But  an  effectual  mode  of 
treatment  for  the  man  might  be — it  is  often  the 
most  effectual  of  all — to  envelope  him  in  a  wet  sheet 
pack   for   an   hour;    to   restrict  his   diet,    so    that 


213 

he   shall   use   up  some   of    the  unused   stuff  that 
is    in    him  ;    and   to  renew  the  application  of  the 
pack  at    intervals    till   his   temperature   and  pulse 
fall,   and   the   exudation   into   the  oppressed  lungs 
is  resolved   and   eliminated  from  the  body.     Here 
excess    of  exposure    to    cold    makes    a    man     ill, 
and  judicious  exposure  to  moderate  and  quantified 
amounts    of    the    same    agent    makes    him    well. 
If,    now,     instead    of  taking    the    case    of    what 
is    called    acute    illness,    the    case    in    which    the 
exposure  to  the  cause  acts  suddenly  and  severely, 
we    try    to    imagine    the     slower    action    of    the 
cause,    when    it    is    continuing    to   act   for   a   con- 
siderable  length  of  time,   we  shall  get  some  light 
on  the  subject.     Suppose  a  person  to   be  exposed 
not   to   sudden   and   severe   cold,    but   to   slighter 
amounts  of  it  acting  for  longer  periods.     Suppose 
also  that  the  body  is  subjected  to  a  slow  but  not  at 
any   time    excessive   condition   of    over-feeding.   So 
slow,  indeed,  that  the  body  may  be  made  gradually 
to  be  tolerant  of  the  irritation.      We  can  imagine 
(what  frequently  happens),  that  slowly  the  body  is 
depressed,  and  that  its  powers  are  lowered,  that  the 
pulse    may     fall,     and    the    temperature    may    be 
diminished,  till   they   seem   to   permanently    shew 
depressed  readings.     If  acute  or  sub-acute  attacks 
of    illness,    repeated     "colds,"     for     example,     or 
repeated   attacks   of    influenza,  supervene,  as  they 
often  do,  the  tone  of  the  body  is  so  much  lowered, 
it  is  so   much    depressed,    and   the   action   of    the 
depressing  agents,  the  cold  and  the  over-feeding,  are 


214 

so  slow  and  gradual,  that  even  the  reaction  of  the 
sub-acute  attack  is  not  great.  The  patient  has 
only  a  slight  elevation  of  temperature,  to  99°  F.  or 
100°  F.,  say,  after  the  subsidence  of  which,  it  falls 
down  again  to  its  former  level  of  96°  or  97°.  It 
seems  that  it  is  quite  easy  in  this  condition  to 
mistake  the  effects  of  too  much  for  the  effects  of 
too  little.  This  is  an  example  of  our  first  paradox 
(since  depression  may  be  caused  both  by  too 
much  and  by  too  little),  that  opposite  causes 
induce  the  same  state.  But  further  examination 
also  shews  that  the  depression  alternating  with 
the  feverishness  are  both  effects  of  the  same 
causes,  and  therefore  it  shews  the  action  of  the 
second  paradox,  that  the  same  causes  induce 
opposite  states.  We  may  put  this  in  another  way, 
and  say  :  irritation  with  tolerance  causes  depression, 
while  irritation  with  intolerance  causes  elevation  or 
fever,  or  at  least  feverishness ;  but  both  depression 
and  elevation,  both  a  too  low  temperature  and  a 
too  high  temperature,  are  the  effects  of  long 
continued  irritation.  In  point  of  fact  it  is  far 
rather  the  long  continued  improper  feeding,  the 
long  continued  excess  of  irritation,  which  is  the 
main  cause  both  of  the  depression  and  the 
feverishness,  than  the  prolonged  exposure  to  cold, 
so  that,  if  a  person  is  properly  fed,  neither  taking 
too  much  on  the  one  hand  nor  too  little  on  the 
other,  he  will  not  be  put  about  or  made  ill  by  any 
moderate  exposure  to  cold  such  as  he  may 
experience  in  the  ordinary  conditions  of  English  or 


215 

European  life.  I  think,  however,  that  I  have 
shewn  not  only  that,  in  accordance  with  paradox  I., 
opposite  causes  induce  the  same  state,  but  also 
that,  in  accordance  with  paradox  II.,  the  same 
causes  induce  opposite  states,  and  that  these 
opposite  states  are  apt  to  alternate  with  one 
another.  If  we  think  of  it  we  shall  find  that  the 
frequent  alternation  of  depression  with  feverishness, 
of  too  low  a  temperature  with  one  too  high,  might 
be,  and  often  is,  termed  irregularity  of  action. 
And  from  this  it  will  follow  that  a  constant  or  long 
continued  irritation,  acting  on  the  body,  induces 
not  only  deficiency  of  function  and  excess  of 
function,  but  also  irregularity  of  function.  And 
from  these  considerations  arises  also  the  practical 
conclusion,  so  important  it  seems  to  me,  that  in  the 
medical  management  of  the  body  its  importance  can 
hardly  be  exaggerated :  If  you  find  defect  of 
function,  irregularity  of  function,  or  excess  of 
function,  look  for  a  constant  cause,  or  at  least  for 
one  acting  at  very  short  intervals  over  a  long 
period  of  time.  As  by  far  the  most  important 
cause  is  improper  nutrition,  and  as  the  form  which 
this  takes  is  far  oftener  over-nutrition  than  under- 
nutrition, the  practical  conclusion  that  emerges  is 
this  :  If  you  find  yourself  suffering  from  defect  of 
function,  from  irregularity  of  function,  or  from 
excess  of  function,  look  for  a  frequently  acting 
cause,  and  recollect  that  most  frequently  (perhaps 
three  times  out  of  four,  or  five  times  out  of  six,  or 
oftener),  that  frequently  acting  cause  will  be  found 


216 

to  be  too  much  food.  Next  to  that,  probably,  it 
will  be  found  that  improper  relations  between  the 
body  and  air  are  the  chief  cause  of  illness  (for  illness 
is  either  defect,  or  irregularity,  or  excess  of  function). 
Next  to  the  relations  of  the  body  to  air,  probably, 
it  will  be  found  that  those  to  work  or  occupation 
will  be  important,  after  which  a  variety  of  other 
causes,  like  anxiety  and  exposure  to  various  of  the 
exciting  causes  of  illness,  will  take  rank,  such,  e.g., 
as  damp,  cold,  moisture,  dryness,  &c. 

This  chapter  is  becoming  long,  but  the  import- 
ance of  the  subject  is  great,  and  there  are 
difficulties  connected  with  it,  some  of  which  I  hope 
are  now  less  in  the  mind  of  the  reader  than  when 
he  began  to  consider  them,  I  do  not  wish  to 
labour  the  matter  further,  so  will  close  this  chapter 
with  an  illustration  from  the  course  of  business  or 
trade.  There  are  two  conditions  in  which  business 
tends  to  be  depressed,  or  even  to  come  to  a 
stand-still.  The  first  is  when  there  are  no  stocks 
on  hand,  for  when  tradesmen  have  nothing,  they 
can  neither  buy  nor  sell  (unless,  indeed,  they  deal 
speculatively  in  things  which  do  not  exist,  which 
is  not  legitimate  business).  But  the  second 
condition  in  which  business  tends  to  come  to  a 
stand-still  is  when  stocks  are  so  heavy  that 
merchants  are  afraid  to  do  business  for  fear  that, 
instead  of  being  able  to  make  a  profit,  they  may 
sustain  a  loss.  In  the  former  case  business  is 
checked  by  too  little,  it  is  starved  ;  in  the  second 
it  is  clogged  by  too  much,  it  is  suffering  from  the 


217 

starvation  of  over-repletion.  This  is  the  first 
paradox :  opposite  causes  have  induced  the  same 
state.  We  have  now  to  see  in  illustration  of  the 
second  paradox  that  the  same  causes  induce 
opposite  states,  how  the  alternation  of  boom 
and  panic  in  business  is  the  efiect  of  a  constant 
and  a  frequently  acting  cause  in  the  commercial 
organism,  just  as  the  alternation  of  fever  and 
depression  is  the  mark  of  such  a  cause  in  the 
physiological  organism.  The  cause  in  the  one 
case  is  an  unrestricted  desire  for  gain  on  the  part 
of  the  merchant.  The  cause  in  the  other  case  is  a 
too  unrestricted  or  ungoverned  desire  for  food  on 
the  part  of  the  man,  woman,  or  child.  When  the 
desire  for  gain  on  the  part  of  the  merchant  is 
natural,  reasonable,  right,  neither  too  great  nor  too 
small,  then  the  course  of  business  shews  moderate 
elevations  at  some  periods,  alternating  with  periods 
of  less  activity,  or  of  moderate  depression  at  others. 
But  there  are  no  inflated  booms  on  the  one  hand, 
and  no  panic  depressions  on  the  other.  Let, 
however,  the  desire  for  gain  be  too  great,  dispro- 
portionate, inordinate,  and  then  we  get  cornering 
and  other  devices  introduced,  means  intended 
to  gain  monopoly  for  ourselves  while  we  are 
attempting  to  deprive  our  neighbour  of  his  fair 
share  of  business  and  of  profit.  The  consequences 
of  this  are  booms  alternating  with  panics,  inflated 
prices,  when  things  are  not  worth  for  life  what  they 
are  fetching,  alternating  with  times  when  they  do 
not    fetch   anything   like   their  real  value   to  life. 


218 

We  have,  therefore,  excess  of  business  —  too 
great  excess — alternating  with  defect — too  great 
defect — and  the  whole  marked  by  irregularity; 
just  as  we  have  feverishness,  depression,  and 
irregularity  in  the  bodily  functions,  arising  from 
too  unrestricted  desire  for  food  on  the  part  of  the 
man.  But  just  as  we  may  infer  from  defect  of 
business,  excess  of  business,  or  irregularity  of 
business,  that  there  is  a  constantly  or  frequently 
acting  cause  to  account  for  it,  and  that  an 
unrestricted  desire  for  gain  is  far  the  most  likely 
cause  to  account  for  these  conditions ;  so  we  may 
infer  from  defect  of  function,  from  excess  of 
function,  or  from  irregularity  of  function  in  the 
physiological  organism,  that  there  is  a  constantly  or 
frequently  acting  cause  to  account  for  it,  and  that 
far  the  most  likely  cause  is  a  too  unrestricted 
desire  for  food  on  the  part  of  the  man.  Here  also 
in  both  of  these  cases  it  appears  to  me  that  the 
thought  is  before  the  thing,  not  the  thing  before 
the  thought,  that  it  is  the  desire  which,  being 
gratified,  causes  the  irregularity,  the  excess,  or  the 
defect  of  the  function,  pointing  to  the  conclusion 
to  which  the  study  of  life  in  all  its  aspects  seems  to 
lead,  that  the  government  of  desire  and  a  wise 
self-restraint  make  things  go  well,  and  safely,  and 
properly.  So  then  if  on  the  one  hand  we  see  the 
organism  healthy  and  active  in  the  pursuit  of  good, 
which  is  to  be  shared  with  all  its  fellows,  we  may 
feel  assured  that  there  has  been  a  wise  government 
of  desire,  and  if  on   the   other   we  see  commerce 


219 

pursuing  a  course,  not  monotonous,  indeed,  but 
varying  within  certain  well  marked  limits,  neither 
marked  by  boom  nor  by  panic  ;  we  may  also  infer  on 
the  part  of  the  business  community  a  wise  and  just 
self-restraint,  a  well  ordered  thought,  which  has 
translated  itself  into  that  suitable  and  proper 
thing. 


220 


CHA.PTEE    VII. 


Some  Further  Observations  on  the  Two  Great 
Medical  Paradoxes  as  related  to  Changes 
in  Function. 


FS  health  and  disease  shade  off  into  one  another 
by  insensible  gradations,  it  is  often  difficult 
to  say  where  the  one  ends  or  where  the  other 
begins.  Would  it,  for  instance,  be  a  just  or  normal 
use  of  words  to  say  that  a  man  whose  sleep  function 
was  disturbed,  was  diseased,  and  if  so,  at  what 
point  in  sleeplessness  should  we  say  that  disease  set 
in  ?  If  a  man  does  not  sleep  for,  say,  one  night  or 
for  two  nights,  are  we  justified  in  saying  of  him  he 
is  diseased  ?  Want  of  ease,  dis-ease  in  this  sense, 
he  is  suffering  from ;  but  I  think  it  will  be 
admitted  that  to  speak  of  such  a  man  as  being 
diseased  would  scarcely  be  to  use  the  words  disease 
or  diseased  in  their  ordinary  sense.  Where,  then, 
is  the  difference  between  health  and  disease  to  be 
found  ?  Suppose,  for  instance,  that  in  place  of  the 
function  of  sleep,  we  were  discussing  the  function 
of  circulation,  or  of  respiration,  or  of  intestinal 
action.  If  we  define  the  function  of  circulation  in 
health  as  corresponding  with  a  pulse  rate  varying 


221 

between,  say,   60    and   90   beats  a  minute,   and  if 
we  find   a  man  with   a    pulse   rate  of   55   on  the 
one   hand,    or    one   with    a   pulse    rate   of    95    on 
the    other,    are    we    justified   in    saying,    on    this 
evidence   alone,  that   either   of  them   is  diseased  ? 
Scarcely,  I  think.     Although  a  healthy  pulse  rate 
is  generally  found  to  coincide  with  a  rate  of  not  less 
than  60,  or  not  more  than  90  a  minute,  still  it  is  a 
difficulty  that,  when  deahng  with  organic  affairs  or 
the  phenomena  of  organised  bodies,  and  especially 
when   dealing    with   the   phenomena   of    organised 
bodies  so   complicated  as  the  human  economy,  we 
cannot  offer  definitions  which  are  true  to  a  nicety. 
Health    shades    off    into     disease     by     insensible 
gradations,    and    although,    as    a    rule,    a    healthy 
pulse     rate     is     generally    found    to    be    running 
as  stated,  and  a  healthy  respiratory  rate  between, 
say,   13  and  18  a  minute,  and  although  a  healthy 
temperature    is   generally   about   98*4°  F.    (37°  C), 
still    we    should     not    be     justified,    I    think,    in 
saying — at  least  I  think  it  would  scarcely  accord 
with  the  ordinary  usage  of  words,   if  we  were   to 
say  that  a  pulse  rate  of  55  on  the  one  hand,  or  95 
on  the  other,  or  a  respiration  rate  of  12  or  of  20  a 
minute,  or  a  temperature  of  97*5°  F.  or  of  99°  F. 
were    necessarily    marks    or   proofs   of  disease.     I 
should  at  least  scarcely  feel  justified  in  speaking  or 
writing  in  this  sense,  although  I  daresay  I  should 
feel  less  difficulty  in  admitting  that  a  condition  of 
disease  were  present  if  I  observed  a  pulse  rate  as 
low  as  40  on  the  one  hand,  or  as  high  as  120  on  the 


222 

other.     Where,    then,    it   may   be    asked,     is    the 
difference  between  functional  alteration  and  organic 
disease  ?       This     is     rather    a    difficult    question, 
although  no  more  difficult  than  many  others  which 
call  for  answer  in  other  domains  of  knowledge.     No 
child  would  confound  a  dog  with  a  gooseberry  bush, 
and  yet  it  might  tax   the  wit  and  information   of 
the  keenest  and  best  stored  intellect  to  offer   such 
definitions    as    would    separate    logically    and    in 
characters  all  plants  from  all  animals.      The  fact  is 
that  animals  and  plants  shade  off  into  one  another 
by   gradations  so   insensible    that    it    is   sometimes 
very   difficult,    and   sometimes   even  impossible,   in 
classifying   a  given  specimen,  to  be  sure  to   which 
class  or  kingdom  we  ought  to  refer  it.     This  kind 
of    difficulty,    indeed,    abounds    in    our    study    of 
nature.     Even  between  things  so  immensely  apart 
as  living  and  dead,  or  organic  and  inorganic,  how 
difficult  it  is  to  state  the  differentia.     Or  between 
gaseous    and    fluid,    or    between    fluid   and   solid. 
Practically,    of    course,     these     questions    do     not 
trouble  us,  or  not  very  often  ;    but   academically  it 
must    be   admitted   that   they   present  very  great 
difficulties  indeed.     Between  sane  and  insane  again 
the    experience    of    our    law    courts,    as    well    as 
judgments  of  sensible  and  unbiassed  persons,  shew 
how  difficult  it  is  to  draw  a  dividing  line.     Insane 
people  do  not  necessarily  do  insane  things ;  in  fact 
they  comparatively  seldom  do  so  ;  but  they  do  sane 
things    (if,    indeed,    one   may   speak   of    things   or 
actions  as  being  sane  or  insane  ?)  in  an  insane  way. 


223 

But  who  shall  say  certainly  whether  a  given  action 
was  that  of  a  sane  or  of  an  insane  person  ?  Dis- 
proportion is  probably  the  most  unfailing  mark  of 
insanity,  the  failure  to  make  ideas,  and  the  actions 
springing  from  them,  to  correspond  with  the 
realities  of  things  ;  and  therefore  persons  are  said 
to  be  sane  or  insane  much  rather  because  of  the 
ways  in  which  they  do  things,  than  because  of 
the  things  themselves  which  they  do.  In  fact  the 
things  done  by  insane  persons  are  very  often  things 
which  require  to  be  done  by  sane  persons,  but 
insane  persons  do  them  in  excess,  either  greatly  too 
much  and  too  vehemently,  or  greatly  too  little  and 
too  casually,  or  they  may  fail  to  do  important 
things  at  all.  But  to  decide  whether  a  given  action 
was  that  of  a  sane  or  insane  person,  is  often  so 
difficult  that  one  expert  may  think  it  was  the  action 
of  a  sane  person,  and  another  may  think  it  was  not. 
Similarly  with  the  intestinal  function,  which  we 
expect  to  act  once  a  day.  We  should  hardly  say  if 
it  missed  a  day  on  the  one  hand,  or  acted  twice  a 
day  on  the  other,  that  a  man  was  diseased ; 
although  if  there  were  inaction  for  a  fortnight,  or 
five  or  six  motions  in  a  day,  we  might  be  more 
disposed  to  admit  that  he  was  so.  The  difficulty  is 
that  both  of  these  opposite  conditions  may  be 
present  without  the  person  thinking  himself  ill 
enough  to  consult  a  doctor,  although  he  did  not  in 
either  case  think  that  he  was  quite  well.  Perhaps, 
however,  persons  look  with  more  equanimity  or 
with  less  mental  disturbance  on  the  former  state  of 


224 

inaction  than  they  are  disposed  to  do  on  the  latter 
state  of  over-activity. 

These  cases  are  instances  of  the  well  known 
difficulty  of  drawing  the  line,  a  difficulty  which 
meets  us  in  so  many  cases  in  life  that  each  of  us  at 
once  thinks  of  many  instances  in  which  he  has 
experienced  it.  And  in  the  present  case,  although 
we  cannot  absolutely  separate  (can  we  absolutely 
determine  anything  ?)  between  alteration  of  function 
and  disease,  we  may  make  an  approximation  to  the 
statement  of  the  differentia  ;  and  the  test  that  I 
think  may  be  offered,  practically,  is  that  in  disease 
there  is  generally  present  some  exudation  from  the 
blood,  or  from  the  lymph,  in  some  part  or  parts  of 
the  body,  while  in  merely  functional  disturbance 
there  is  not.  I  quite  admit  that  there  are  cases, 
well  recognised  to  be  cases  of  disease,  where  no 
such  exudation  can  be  shewn  to  be  present,  a  mild 
feverish  attack,  for  instance,  or  a  mild  attack  of 
typhus  fever,  or  of  measles.  But  as  shewing  how 
functional  change  and  disease  shade  off  into 
one  another,  we  have  only  to  picture  a  very  severe 
case  of  typhus  fever  in  which  exudations  take 
place  into  the  arm  pits  and  groins,  and  result  in 
suppurations  such  as  are  sometimes  seen  in  plague. 
From  this  point  of  view,  sleeplessness  would  not  be 
a  mark  of  disease,  although  it  would  be  a  mark  of 
functional  disturbance,  unless  we  could  shew,  or 
unless  it  were  likely,  that  some  exudation  from  the 
blood  into  the  parts  of  the  nervous  system,  through 
which  sleep  is  produced,  or  into  its  connective  tissue, 


225 

were  present  to  account  for  it.  So  with  constipation, 
or  with  diarrhoea ;  and  so  with  disturbance  of  cir- 
culation, or  of  temperature,  or  of  respiration,  or  of 
any  other  function  of  the  body.  It  may  be  argued 
that  no  change  of  function  occurs  in  the  body 
without  some  corresponding  temporary  change,  say 
of  circulation  or  of  nervous  action,  leading  insensibly 
to  change  of  structure.  That  may  be  so.  But  so  long 
as  we  cannot  shew,  or  render  likely  by  reasoning 
the  presence  of  some  exudation  from  the  blood, 
somewhere  in  the  body,  as  accounting  for  the 
disturbance  of  these  functions,  we  use  the  term 
disturbed  function,  or  functional  disturbance,  rather 
than  disease.  If,  on  the  other  hand,  we  know  or 
think  that  we  know  that  there  is  anywhere  in  the 
body  some  exudation  to  account  for  the  disturbances, 
then  we  speak  of  disease.  I  believe  myself  that  a 
large  number  of  instances  of  functional  disturbance 
commence  in  changes,  and  generally  in  some 
blockage  of  the  lymph  circulation  in  the  capillary 
vessels  lying  between  veins  and  arteries.  Very 
soon,  and  often  impalpably  or  unprovably,  some 
lymph  congestion  of  connective  tissue  sets  in, 
some  phase  of  what  I  have  called  ^Initis,  and  that 
this  is  the  beginning  of  the  process  of  disease  in  a 
very  large  proportion  of  cases.  But,  of  course,  if 
anyone  were  to  argue  that,  before  these  changes 
occurred,  some  previous  mal-assimilation  was 
present,  some  failure  to  assimilate  nutriment,  this  in 
turn  being  caused  by  unsuitability  in  food  supply  as 

*  See  Chapter  YIII.  for  a  full  account  of  Initis. 


226 

regards  its  quantity,  quality,  or  frequency,  this 
statement  would  also  accord  with  my  view. 
Practically,  I  should  say  that  disease  generally  or 
almost  always  begins  at  some  point  in  the  digestive, 
and  blood  making,  and  lymph  circulation  processes, 
that  is,  that  disease  is  a  form  of  mal-nutrition. 
And  I  have  a  general  opinion  formed  from  the 
evidence  offered  throughout  this  essay,  that  the 
particular  phase  of  mal-nutrition  which  is  commoner 
than  all  the  rest  put  together,  or  at  least  the  most 
common,  is  the  mal-nutrition  which  comes  from 
excess  of  food.  Then  the  most  usual  change  to 
which  this  excess  of  food  gives  rise  is  over-growth  of 
the  connective  tissue ;  so  that,  if  we  had  functional 
change  in  the  connective  tissue  of  a  nerve,  we 
should  speak  of  neuralgia  (vevpov  =  nerve,  and 
a\yos  =  pain),  while  if  we  had  exudation  present,  or 
thought  we  had,  either  in  the  nerve  or  in  its  sheath, 
we  should  speak  of  neuritis  or  peri-neuritis.  The 
former  would  be  functional  disturbance,  the  latter, 
disease.  Mere  sleeplessness  would  be  functional 
disturbance,  but  cerebral  meningitis  or  cerebritis 
itself  would  be  disease.  Palpitation,  that  is, 
irregular  action  of  the  heart,  would  be  functional 
disturbance,  so  long  as  there  was  no  organic  change 
in  the  organ ;  but  endo-carditis,  or  peri- carditis, 
or  carditis  itself  would  be  disease.  And  so 
with  mere  constipation  and  mere  diarrhoea  as 
contra-distinguished  from  enteritis  or  peri-enteritis 
{peri-typhlitis,  e.g.,  which  is  a  rather  more  familiar 
term).     Perhaps  I  ought   to  explain  here,    for  the 


227 

information  of  the  general  reader,  the  meaning  of 
the  termination  tfis,  appearing  in  the  words 
neuritis,  cerebritis,  enteritis,  bronchitis,  &c.  The 
termination  itis  is  the  end  of  a  Greek  feminine  ad- 
jective, meaning  of  or  belonging  to,  and  agreeing 
with  vocros  or  i/ovo-os  =  disease,  understood.  Thus 
cerebritis  would  be  a  diseased  condition  of  or  belong- 
ing to  the  cerebrum  or  brain ;  enteritis  would  be  a 
diseased  condition  of  or  belonging  to  the  evrepov  or 
bowel ;  bronchitis  would  be  a  diseased  condition  of  or 
belonging  to  the  bronchial  mucous  membrane,  &c., 
&c. ,  &c.  The  termination  would  always  point  to  a 
diseased  condition  of  the  part  of  the  body  named  in 
the  beginning  of  the  word.  But  as  it  was  soon 
seen  that  the  commonest  diseased  condition  of  parts 
was  inflammation  of  the  parts,  the  termination  itis 
has  for  a  long  time  now,  by  general  consent,  come 
to  mean  inflammation  of  the  part  pointed  to  by  the 
beginning  of  the  name.  Thus  cerebritis  means 
inflammation  of  the  cerebrum  or  brain,  enteritis 
means  inflammation  of  the  enteron  or  bowel,  &c. 
In  all  these  conditions  there  is  an  exudation 
temporarily  efiused  into  the  parts,  and  so  in  the 
generality  of  cases  the  difierentia  that  separates 
disease  from  mere  functional  disturbance  is  found  to 
be  present.  With  one  word  more  I  may  for  the 
present  dismiss  this  discussion.  The  bodily  organs, 
and  even  the  tissues,  very  frequently  consist  of 
three  parts.  (1)  The  tissue  or  organ  proper,  its 
interior  part,  so  to  call  it,  or  what  is  sometimes 
termed    its    parenchyma.      (2)     Its    coverings,    or 

02 


228 

sheaths,  or  envelopes,  These  coverings  are  gener- 
ally two,  the  inner  and  the  outer.  The  Greek  term 
for  a  covering  being  etXe/x/Aa,  inflammation  of  the 
€tXe/x/xa  becomes  eilemmatitis  or  ilemmatitisy  and 
hence  we  say  diseases  are  parenchymatous,  on  the 
one  hand,  when  the  intimate  central  structure  of 
the  organs  is  inflamed,  and  they  are  eilemmatous ,  or 
ilefnmatous,  on  the  other,  when  the  coverings  are 
inflamed.  As  either  the  inner  or  the  outer  covering 
may  be  inflamed,  we  sometimes  speak  of  end- 
ilemmatous  {evhov  =  within)  and  ex-ilemmatous 
{Ik  or  e^  =  without).  An  end-ilemmatous  disease 
would  be  represented  by  bronchitis  or  inflammation 
of  the  inner  lining  membrane  of  the  lungs,  while 
pleuritis  or  pleurisy  would  be  the  name  used  of 
inflammation  of  their  outer  or  serous  membrane. 
Sometimes  the  inflammation  of  the  outer  covering 
is  referred  to  by  the  Greek  preposition  irepl  =  around, 
and  hence,  instead  of  ex-enteritis  or  exo-typhilitis, 
we  speak  of  peri  -  enteritis  and  peri  -  typhilitis, 
meaning  inflammation  of  the  parts  around  the 
rv<l?\ov  or  blind  portion  of  the  bowel  (the  Latin 
caecum),  so  named  because  it  ends  in  a  cut  de  sac. 
So  much  it  seemed  necessary  to  say  in  order  to 
clear  up  some  points  in  medical  terminology, 
which  seem  sometimes  to  create  confusion  in  the 
minds  of  readers. 

We  can  now  go  on  to  discuss  a  little  more  at 
length  the  alterations  of  function,  which  appear 
according  as  more  or  less  stimulus  is  acting  on 
the   body.     From  time  to  time  it  will  be   evident 


229 

that  function  shades  off  into  disease  by  insensible 
gradations,  so  that  it  is  often  difficult  to  differentiate 
the  one  from  the  other.  But  the  propositions  I  am 
about  to  make  are  true,  it  seems  to  me,  of  function 
rather  than  of  disease.  The  general  proposition  or 
propositions  are  : — (1)  In  the  absence  of  stimulus 
there  is  no  function ;  (2)  in  the  presence  of  too 
much  stimulus  there  is  also  no  function  ;  and  (3) 
when  stimulus  is  moderate  and  proportionate 
function  is  normal  and  healthy.  We  saw  that 
these  propositions  appear  to  be  true  for  the  functions 
of  intestinal  action  and  of  sleep.  We  have  now  to 
see  that  they  can  be  generalised,  when  they  will  be 
found  to  be  true  of  all  functions.  Of  course,  to  do 
this  completely  would  involve  a  considerable  amount 
of  labour,  since  to  prove  it  completely  would  be  to 
evolve  a  complete  treatise  on  physiology,  on  the  one 
hand,  and  a  complete  account  of  the  practice  of 
medicine  on  the  other.  But  short  of  this  too  great 
task,  it  is  possible  for  us  to  get  much  probable 
evidence  of  the  truth  of  this  generalisation.  And 
the  stimulus,  which,  as  in  the  case  of  sleep  and 
intestinal  function,  has  an  inffaence  so  great  as  to 
cast  all  others  into  the  shade,  is  the  stimulus  of 
food  supply.  Other  forms  of  stimulus  are  important, 
no  doubt,  but  this  is  the  chief,  and  that  by  a  long 
way.  It  is  not  necessary  for  us  to  depreciate 
the  effects  of  air  on  the  body,  or  of  work,  or 
of  anxiety.  In  some  ways,  indeed,  the  effects 
of  air-supply  on  the  economy  are  more  noticeable 
than  are  the  effects  of  food-supply ;  for  deprivation 


230 

of  air  for  even  a  few  minutes  brings  life  to  an 
end ;  while  the  body  can  go  on  without  food 
(if,  that  is,  it  is  meanwhile  supplied  with  water) 
for  an  indefinite  number  of  weeks,  according  to  the 
resistance  of  the  organism,  but  certainly  in  many 
cases  for  not  less  than  six,  while  some  persons  have 
lived  without  food  for  eight  or  ten  weeks  and  even 
longer.  I  suppose  this  is  one  of  the  reasons  why  in 
our  sanitary  discussions,  and  in  our  practical  measures 
founded  on  our  sanitary  ideas,  so  much  attention 
has  been  given  to  the  effects  of  air  supply,  and  so 
little  to  the  effects  of  food.  I  do  not  know  for  how 
long  an  average  person,  not  exposed,  say,  to 
extremes  of  weather,  can  live  without  both  food 
and  water.  For  how  long,  for  instance,  could  an 
average  adult  of  35  years  of  age,  and  in  average 
health,  live,  say,  in  a  covered  boat  gently  rocked  on 
a  calm  and  temperate  sea,  if  deprived  of  food  and 
water  ?  Perhaps  two  or  three  weeks  ?  But  if 
supplied  with  water  and  deprived  of  solid  food,  he 
can  live  for  six  or  eight  or  more  weeks.  But  if 
deprived  of  air  (and  this,  however  he  had  been  fed 
before),  for  not  longer  than  a  few  minutes.  There 
is  a  very  great  and  very  marked  difference.  The 
effects  of  work  or  muscular  movements,  again,  or  of 
anxiety,  are,  like  the  effects  of  food,  of  an  indefinite 
length  of  duration,  so  that  the  same  difficulties 
present  themselves  to  us  in  the  attempt  to  guage 
the  effects  of  these  as  in  that  to  shew  the  effects  of 
food.  There  is  a  P-reat  difference  then  between  the 
view  here  stated,  that  food  supply,  the  defect  of  it. 


231 

the  excess  of  it,  the  irregularity  of  it,  and  the  good 
or  bad  quahties  of  it,  is  far  the  most  important 
cause  of  alteration  of  function  in  the  body  (leading 
to  disease,  no  doubt,  since  function  and  disease 
shade  off  into  one  another  by  insensible  gradations) 
— there  is  a  great  difference  between  this  view  and 
that  which  should  state  that  food  supply  is  the  only 
predisposing  cause  of  disease  in  the  body.  Anyone^ 
indeed,  who  should  attempt  to  argue  the  latter 
view,  would  put  himself  out  of  court  at  once, 
rendering  himself  unworthy  to  obtain  a  hearing. 
My  argument,  then,  in  attempting  to  shew  that 
food  supply  is  the  chief  cause  of  illness,  must  take 
the  form  of  shewing  that  when  defect  of  function 
exists,  on  the  one  hand,  when  excess  of  it  exists,  on 
the  other,  or  when  irregularity  of  it  is  present, 
these  abnormalities  can  be  made  to  disappear  by 
alterations  in  the  diet  better  than  by  any  other 
means.  To  do  this  I  propose  to  attempt  to  deal 
with  other  functions  besides  those  of  sleep  and 
intestinal  action,  with  which  I  have  ah-eady  dealt. 
Let  us  consider  (1)  circulation,  (2)  nutrition,  as 
shewn  in  obesity  and  in  attenuation,  (3)  respiration, 
(4)  renal  action,  (5)  the  heat  function  of  the  body, 
or  the  maintenance  of  its  temperature,  and  (6) 
cerebration,  or  thinking,  feeling,  &c.  In  dealing 
with  all  these  (as  also  with  others,  which,  however, 
are  not  quite  suitable  for  general  discussion),  it  will 
be  found  that  the  paradoxes  formerly  stated  hold 
good  as  practical  conclusions,  and  that  we  may 
say  :  — 


232 

1.  Circulation.  Too  great  slowness  of  the 
pulse,  say  a  pulse  of  40  a  minute  or  even  20  a 
minute  ;  too  great  quickness  of  the  pulse,  say  up 
to  130  or  140  a  minute;  and  irregularity  of  the 
pulse,  all  may  and  often  do  depend  on  an  excess 
of  food,  and  all  can  be  combated,  therefore,  by 
restriction  of  the  diet.  Otherwise,  we  can  quicken 
a  slow  pulse  or  render  regular  an  irregular  one  (that 
is,  one  which  is  now  too  slow  and  then  too  quick), 
by  the  same  means  by  which  we  can  slow  a  quick 
pulse,  namely,  by  restricting  the  diet. 

2.  Nutrition.  Too  great  thinness  and  too 
great  stoutness,  and  the  state  in  which  persons 
sometimes  become  too  stout,  quickly,  and,  again, 
too  thin,  quickly  (in  which  nutrition  is  irregular), 
all  may  and  often  do  depend  on  excess  of  food  ; 
and,  therefore,  we  can  often  fatten  too  thin  persons 
and  render  much  more  regular  the  nutrition  of 
persons  who  thin  and  fatten  alternately,  at  too 
short  intervals  of  time — we  can  regulate  these 
abnormalities  by  the  same  means  by  which  we 
reduce  or  thin  obese  persons,  namely,  by  restricting 
the  diet. 

3.  Respiration.  Too  great  slowness  of  respir- 
ation (below  twelve  a  minute,  e.g.),  too  great 
quickness  of  respiration  (above  twenty  a  minute, 
e.g.),  and  irregularity  of  respiration,  that  is,  the 
state  in  which  too  great  slowness  at  some  times 
alternates  with  too  great  rapidity  at  other  times, 
may  and  often  do  depend  on  an  excess  of  food. 
And,  therefore,  we   can   frequently  quicken  a  too 


233 

slow  respiration,  and  regulate  an  irregular  one,  by 
the  same  means  universally  adopted  to  slow  a  too 
quick  respiration,  namely,  by  restricting  the  diet. 

4.  Renal  action.  Too  scanty  and  loaded 
urine,  as  well  as  too  thin  and  too  abundant 
urination,  as  well  as  irregularity  of  the  function, 
when  too  scanty  urination  alternates  too  rapidly 
with  too  abundant  functioning,  all  may  and  often 
do  depend  on  an  excess  of  food.  From  which  it 
follows  that  we  can  frequently  increase  a  too 
scanty  urination,  and  regulate  an  irregular  flow, 
by  the  same  means  by  which  we  can  reduce  a  too 
abundant  flow  (as,  e.g.,  in  what  is  termed  diabetes 
insipidus  or  even  diabetes  mellitus),  viz.,  by 
restricting  the  diet. 

5.  Temperature  of  the  body.  Lowness  of 
temperature  in  the  body  (a  temperature  of  96°  F., 
or  less,  e.g^.,  elevation  of  temperature  in  the  body 
(a  temperature  of  102°  or  103°  F.,  e.g^,  and 
irregularity  of  temperature  in  the  body,  that  is, 
the  state  in  which  a  too  low  temperature  alternates 
at  too  short  intervals  of  time  with  a  too  high 
temperature  —  these  three  states  of  disturbed 
temperature  all  may  and  often  do  depend  on  an 
excess  of  food.  From  which  it  follows  that  we 
can  frequently  elevate  a  too  low  temperature,  or 
regulate  an  irregular  one,  by  the  same  means  which 
are  almost  universally  adopted  to  reduce  a  too  high 
one,  viz.,  by  restricting  the  diet. 

6.  Dulness  of  cerebration,  or  mentalisation, 
or  thinking,   when  the   person's  mind  is   lethargic 


234 

and  sluggish,  when,  e.g.,  he  tends  to  fall  asleep 
if  he  tries  to  think  or  even  to  read ;  also  too 
great  rapidity  and  want  of  continuity  in  thinking, 
when  he  cannot  keep  his  mind  on  one  subject  for 
any  length  of  time,  but  flies  off  suddenly  to 
another  ;  as  also  the  condition  of  mind  in  which 
sluggish  thinking  alternates  too  rapidly  with  excited 
and  perhaps  flighty  thinking — these  three  states  of 
disturbed  mental  function  may  and  often  do  all 
depend  on  an  excess  of  food.  From  which  it 
follows  that  we  can  frequently  quicken  the  thinking 
powers  in  too  great  sluggishness,  regulate  them  in 
too  rapid  alternation  of  quickness  and  slowness  of 
thinking,  and  slow  them  when  the  processes  are  too 
quick — we  can  often  effect  all  these  changes  by 
restricting  the  diet. 

If  the  critic  were  to  say,  as  perhaps  he  will 
say,  that  all  these  changes  in  the  various  functions 
of  the  body  may  be  brought  about  because  persons 
are  exposed  to  the  influences  of  bad  air,  or  because 
persons  are  deprived  of  proper  exercises,  or  because 
they  are  exposed  to  too  great  anxiety,  or  because 
persons  have  too  many  things  to  think  about,  or 
because  of  the  incidence  of  other  causes,  we  ought 
to  admit  all  these  as  possible  causes,  or  we  might 
theoretically  admit  them  to  be  possible  causes.  But 
practically  I  have  no  doubt  at  all  that  the  influences 
of  any  two  of  these  causes  put  together,  or  even  of 
all  of  them,  are  not  to  be  named  in  the  same  breath 
as  the  influences  of  improper  food  supply.  Further, 
of  the   three   or  four    possibilities  of  food  supply, 


235 

its  excess,  its  defect,  its  irregularity,  or  its  bad 
quality,  I  have  no  doubt  at  all  that  excess  of 
supply,  either  as  to  quantity  or  frequency,  or  both, 
is  far  the  commonest  way  in  which  this  cause  acts. 
So  that  the  practical  conclusion  we  form,  whenever 
we  see  alteration  of  function,  either  as  to  excess  or 
defect  or  irregularity,  is  this  :  In  order  to  rectify 
the  excess,  the  defect  or  the  irregularity,  let  us 
first  restrict  the  diet,  and  see  what  the  result  will 
be.  I  mio;ht  have  added  the  function  of  the  skin 
to  those  already  named,  and  might  have  stated  as 
to  the  action  of  this  seventh  function  :  Too  great 
dryness  of  the  skin,  when,  for  instance,  the  hands 
feel  hot  and  dry ;  too  great  moisture,  as  when  they 
are  wet,  cold  and  clammy ;  and  the  state  in  which 
too  great  dryness  alternates  at  too  short  intervals 
of  time  with  too  great  moisture,  all  may  and  often 
do  depend  on  excess  of  food.  From  which  it  follows 
that  we  can  frequently  relieve  too  great  dryness  of 
the  skin,  as  also  too  great  moisture,  as  also 
irregularity  in  the  manifestation  of  these  condi- 
tions, by  restricting  the  diet.  In  reference  to  the 
skin  function,  I  will  only  say  that  more  than  once 
has  it  occurred  to  me  to  be  able  to  reg-ulate  it  by 
the  simple  advice  to  persons  suffering  in  any  of  the 
ways  named,  that  they  should,  e.g.j  omit  their 
supper. 

Summing  up  then  the  propositions  regarding 
the  relation  of  food  supply  as  a  stimulus  to  changes 
in  function,  we  come  to  the  followino-  state- 
ments : — 


236 

1.  In  the  absence  of  the  stimulus  of  food 
there  is  no  function.  (If  organs  are  not  supplied 
with  nutriment  they  cease  to  act). 

2.  In  the  presence  of  too  much  stimulus 
there  may  also  be  absence  of  function.  (If  organs 
are  supplied  with  too  much  nutriment  they  cease 
to  act.) 

3.  In  the  presence  of  moderate  stimulus  there 
is  normal  function.  (If  organs  are  supplied  with 
their  proper  amount  of  nutriment,  neither  too 
much  nor  too  little,  function  is  normal  or  natural). 
These  are  very  different  propositions,  I  may  say,  from 
the  statement  that  might  have  been  made  that,  for 
example,  absence  of  function  is  caused  by  absence 
of  stimulus.  I  do  not  think  we  are  entitled  to  say 
the  latter.  What  we  are  entitled  to  say  is  that 
absence  of  function  and  absence  of  stimulus  are 
co-ordinated  and  co-related.  We  are  not  entitled 
to  say  which  is  first — which  is  the  cause  of  the 
other — at  least,  not  till  after  a  long  philosophical 
inquiry,  very  interesting,  no  doubt,  to  some  minds, 
perhaps  to  all,  but  to  enter  on  which,  as  it  would 
lead  us  very  far  on  the  present  occasion,  there  is  no 
time  nor  opportunity  for.  Let  me  here  just  remind 
the  reader  of  what  was  before  said  as  to  the  various 
relations  of  thought  and  thing ;  and  ask  him  to 
apply  the  same  ideas  to  the  relation  of  food  supply 
and  function.  Food  supply  would  correspond  with 
the  thing  ;  function  with  the  thought.  The  same 
general  relations  hold  between  food  supply  and 
function  as  between  thing  and  thought. 


237 

The  reader  who  sees  the  statement  that  excess 
of  food  supply  is  a  far  commoner  cause  of  altered 
function  than  either  defect,  or  irregularity  of 
supply,  or  even  than  bad  quality  of  it,  may  find 
himself  in  a  difficulty.  If  he  should  whisper  to 
himself — what  about  poverty,  then? — do  the  very 
poor  also  eat  too  much  and  too  often  ?  It  seems  to 
me  that  they  do.  The  poor,  it  seems  to  me,  eat 
poor  food  too  often  and  too  much,  and  the  rich  eat 
rich  food  too  often  and  too  much,  and  they  are  both 
ill.  Frequent  eating  is  nearly  always  of  too  much 
bread,  cakes,  and  sweets.  I  never  met  any  person, 
man  or  woman,  who  ate  meat  five  times  a  day,  but 
I  have  met  very  many  persons,  especially  women, 
who  took  bread,  not  only  five  times  a  day,  but  even 
six,  seven  and  eight  times ;  and  once  a  woman 
came  under  my  care  who  ate  bread  no  less  than  ten 
times  a  day.  I  got  to  know  all  these  people 
because  they  were  ill — they  suffered  in  a  variety  of 
ways,  from  colds,  headaches,  &c. ;  but  a  way  in 
which  many  of  them  suffered  was  in  being  so  thin, 
so  wasted,  and  so  attenuated,  that  some  of  them 
were  advised  that  they  were  not  having  enough 
food.  A  lady  who  ate  eight  times  a  day,  on 
going  to  a  watering  place,  was  told  :  ' '  Madam,  you 
are  low,  you  are  weak,  you  are  attenuated,  and  you 
must  be  fed  up."  The  advice,  I  suppose,  was  felt 
to  suit  her  complaint,  her  mental  if  not  her  bodily 
complaint,  and  she  got,  as  so  many  people  do,  the 
advice  which  it  was  felt  would  suit  her.  A 
servant  in  a  common  lodging  house,  who  got  up  at 


238 

4-30  in  the  morning,  and  began  with  her  tea  and 
bread  and  butter  then,  keeping  on  at  it  all  day  till 
I  counted  ten  times  that  she  was  taking  it  (the 
ordinary  dinner  about  1-0  p.m.  was  one  of  the 
ten  meals),  she,  poor  thing,  was  advised  to  go 
to  bed  on  nothing  but  milk  and  soup  diet  for  a 
fortnight,  after  which  her  diet  was  cautiously 
increased,  until  she  was  got  on  to  proper  food 
habits  ;  and  she  did  very  well.  She  also  was  low, 
weak,  and  attenuated,  and  she  was  fattened  by 
having  her  diet  for  a  time  greatly  restricted.  Her 
condensed,  and  plugged,  and  obstipated  tissues 
were  drawn  on,  to  deliver  up  some  of  their  too 
solid  constituents,  those  whose  too  close  aggregation 
made  her  too  thin ;  by  this  means  the  blood  found 
its  way  better  to  the  tissues,  and  she  improved  in 
colour  and  aspect  under  restriction,  and  by  and  bye 
increased  in  weight.  But  although,  as  I  say,  bread, 
and  cakes,  and  sweets  are  the  commonest  foods 
which  are  taken  too  often  and  too  much,  and 
although  I  have  never  met  anyone  who  took  meat 
even  as  often  as  five  times  a  day,  not  to  speak  of 
six,  seven,  eight  or  ten  times,  still,  no  doubt,  if 
anyone  did  so  foolish  a  thing,  we  should  find  that 
he  suffered  from  some  form  of  serious  illness. 
The  principle  is  that  too  much  food  and  too 
frequent  consumption  of  it  is  destructive  to  health  ; 
the  accident  that  it  is  nearly  always  bread,  cakes, 
and  sweets,  rather  than  meat,  eggs,  or  game,  which 
are  taken  in  this  unphysiological  and  unhealthy 
way.     I   have   no   experience  of  the  effects  of  the 


239 

appalling  poverty  which  are  said  to  be  experienced 
in  the  east  end  of  London.  I  do  not  know  how 
much  of '^these  effects  is  due  to  crime,  vice,  reckless- 
ness, drink,  and  improvidence ;  but,  judging  from 
experience  in  other  places,  it  seems  as  if  very  careful 
elimination  of  these  sources  of  sickness  would  have 
to  be  made  before  the  effects  pure  and  simple  of 
insufficient  feeding  in  causing  sickness  and  mortality 
could  be  declared  with  any  approximation  to 
accuracy.  In  provincial  England,  at  any  rate, 
whatever  may  be  true  of  the  capital,  even  the  very 
poor,  as  a  rule,  eat  too  often  and  too  much ;  and 
the  charwoman  is  made  ill  and  has  her  life 
shortened,  not  by  insufficiency  of  diet,  nor  yet  by 
the  hard  work  which  she  is  always  talking  about, 
but  by  the  five  meals  which  she  thinks  it  necessary 
to  take  in  order  to  keep  up  her  strength  so  as  to 
be  able  to  do  her  work.  Even  the  beggar's  baby 
suffers  in  the  same  way,  and  from  the  same  causes, 
viz.,  not  too  little  food  too  seldom  administered,  but 
from  taking  it  too  often  and  too  much.  For  the 
beggar's  baby,  which  has  bread  and  tea  at  eight  in 
the  morning,  before  being  taken  out  to  beg,  which 
gets  from  the  hand  of  charity  a  piece  of  bread  and 
butter  at  10-30  in  the  morning,  which  is  taken 
home  at  12-30  or  so  to  dinner  of  bread  and  tea,  and 
which  is  again  fed  with  the  same  food  at  four  and 
at  seven  before  being  put  to  bed,  suffers  also  from  a 
succession  of  "  colds,"  and  often  from  one  or  more 
of  the  "  fevers,"  such  as  measles,  scarlatina, 
diphtheria,    infantile   remittent   fever,   or  the  like. 


240 

These  ailments  are  attributed  to  cold,  exposure, 
infection,  etc.,  and  it  seems  to  occur  to  but  few  that 
the  chief  predisposing  cause  of  them  is  improper 
feeding.  Nevertheless,  the  sickly  history  of  the 
rich  woman's  child,  in  whose  case  cold  is  avoided 
and  exposure  and  infection  are  carefully  guarded 
against,  shows  that  there  is  a  common  cause  of  the 
illnesses  both  of  the  children  of  the  poor  and  of 
the  rich,  viz.,  improper  feeding,  the  commonest 
form  which  this  takes  being,  not  too  little  food 
administered  too  seldom,  but  too  much  food 
administered  too  often.  Of  course,  occasionally, 
direct  starvation  is  a  cause  of  mortality  among 
infants,  but  the  instances  in  which,  Csg.,  infants  are 
neglected  by  bad  mothers  are  nothing  like  so 
numerous  as  are  those  in  which  they  suffer  from  too 
much  food  injudiciously  administered  too  often. 
The  latter  cause  of  death  often  takes  the  form  of 
what  Dr.  King  Chambers  termed  the  starvation 
of  over-repletion,  or,  as  we  might  term  it,  of 
indirect  starvation — the  former  is  direct  starvation. 
Both  indirect  and  direct  starvation  cause  or  may 
cause  thinness,  wasting  and  attenuation,  but 
obviously  thinness  caused  by  indirect  starvation 
must  be  treated  by  restriction  of  the  diet,  while 
thinness  due  to  direct  starvation  must  be  treated  by 
cautious  increase  of  it.  The  mortality  among 
infants  is  frightful  in  England  and  other  countries. 
How  frightful  may  be  judged  when  we  reflect  that 
among  the  whole  population  of  England  and  Wales 
.about  a  fourth  of  the  children  die  before  they  are 


241 

five  years  of  age.  But,  as  many  careful  and  well- 
advised  mothers  rear  all  their  children,  at  how  great 
a  rate  must  the  others  die,  to  render  the  general 
mortality  so  high  ! 

Mr.  Seebohm  E-owntree's  interesting  book  on 
the  Poverty  of  York  appears  to  me  to  point  in 
the  same  direction.  His  menus  of  the  meals  of  the 
poor  shew  bread  and  jam  four  times  a  day,  and 
sometimes  five  times  a  day  as  the  staple  of  the 
kinds  and  frequency  of  their  food  supply.  This  is 
certainly  in  accord  with  what  strikes  me  as  the  true 
conclusion  in  the  matter  on  the  whole  (there  are 
exceptions,  no  doubt),  when  I  say  that  the  poor  eat 
poor  food  too  often  and  too  much,  and  that  it  is  a 
common  cause  of  their  illnesses.  Two  meals  a  day, 
one  of  which  might  well  enough  be  the  bread  and 
jam  referred  to  (it  is  quite  suitable  for  one  of  the 
daily  meals),  and  the  same  amount  of  money  spent 
on  more  substantial  fare  such  as  frumity  with  suet 
dumplings,  and  some  egg,  or  milk,  or  meat  up  to 
the  value  of  the  three  or  four  bread  and  jam  meals 
which  the  second  meal  replaces,  would  provide  a 
much  healthier  and  more  substantial  dietary,  and 
would  cost  no  more,  would  indeed,  I  think,  cost 
less ;  so  that  the  needs  of  the  family  whose  total 
earnings  are  twenty- five  shillings  a  week  or  less, 
would  be  met,  as  far,  that  is,  as  it  is  possib..3  to 
meet  them  on  such  small  means. 

In  attempting  now  to  make  good  the  statements 
that  both  excess  and  defect  of  function,  as  also 
irregularity    of    function,    are    frequently    due    to 


242 

excess  of  food,  and  that  these  conditions  can  be 
more  easily  treated  by  restriction  of  the  diet  than 
in  any  other  way,  it  is  not  necessary  to  say  much 
regarding  the  treatment  of  excess  of  function,  for 
this  is  almost  invariably  and  by  almost  universal 
consent  treated  in  this  way.  A  too  quick  pulse,  too 
rapid  respiration,  excessive  renal  action,  a  too  high 
temperature,  obesity,  and  even  excessive  mentalisa- 
tion,  as  shewn,  e.g.,  in  delirium  or  too  great 
talkativeness,  are  usually  treated  by  restriction  of 
the  diet.  There  may  perhaps  be  exceptions  in  the 
case  of  excess  of  renal  action,  and  occasionally  in 
that  of  too  great  mentalisation  or  cerebration,  but 
the  almost  invariable  custom  regarding  the  others 
is  to  restrict  the  diet.  As  regards  excessive  renal 
action,  such  as  we  get  in  diabetes,  when  persons  pass 
an  immense  quantity  of  urine,  amounting  perhaps  to 
30  or  40  pints  in  a  day,  the  best  results  can  often  be 
obtained  in  this  way.  In  such  cases  I  have  seen 
the  quantity  brought  down  in  a  few  weeks  from 
many  pints  to  three  or  four  in  a  day,  and  with  a 
great  fall  in  the  specific  gravity,  by  the  administra- 
tion of  milk  and  barley  water,  with  mutton  tea, 
during  the  day,  and  nothing  (except  water)  during 
the  night.  One  such  case  was  that  of  a  young 
woman,  twenty-three  years  of  age,  who  was  brought 
to  me  by  her  mother,  suffering  from  diabetes 
(specific  gravity  of  urine  1040),  many  pints  of 
urine  containing  large  quantities  of  glucose  being 
daily  passed.  There  was  also  some  albuminuria. 
Under  a  diet  of  half  a  pint  of  milk  and  barley- 


243 


water,  equal  parts,  twice  a  day,  and  half  a  pint  of 
mutton  tea  in  the  middle  of  the  day,  continued  for 
six  weeks,  this  young  woman  entirely  recovered, 
after  which  she  was  put  upon  two  meals  a  day,  the 
advice  being  given  her  to  take  a  little  meat  at  one 
of  her  meals  (about  four  ounces),  and  some  bread  at 
the  other.  Under  this  regime  she  remained  well, 
and  then,  feehng  that  she  need  not  keep  so  strictly 
to  orders  as  before,  returned  to  her  usual  three 
meals  a  day.  In  a  year  from  the  time  of  her  being 
first  seen  she  relapsed,  the  old  diabetic  condition 
returning,  and  being  removed  by  the  same  curative 
regime  as  before.  The  second  attack  did  not  last  so 
long  as  the  first  one. 

It  will  be  observed  that  the  theory  on  which 
treatment  in  this  case  was  conducted  was  that  the 
disease  was  due  to  too  much  food  taken  too  often, 
and  not  that  it  was  due  to  too  much  starch  and 
sugar  in  the  diet.  The  advice  given,  therefore,  was 
that  the  patient  should  diminish  her  food  or  restrict 
her  diet,  not  that  she  should  abstain  from  starch 
and  sugar.  I  have  reason  to  believe  that,  had  she 
been  fed  on  milk,  meat  and  eggs — which  the  theory 
that  her  illness  depended  on  too  much  starch  and 
sugar  would  have  necessitated — she  would  not  have 
recovered.  It  is  interesting  that  a  difference  of 
view  so  slight  as  that  a  patient's  condition  depends 
on  too  much  food  rather  than  on  too  much  starch 
and  sugar,  should  make  so  much  difference  to  the 
prospects  of  recovery,  that  on  one  view  she  would 
recover,    and    on    the    other    not.      An    academic 

P2 


2U 

difference  of  opinion  as  to  causation  may  translate 
itself  into  the  difference  between  recovery  and 
non-recovery  in  the  sphere  of  treatment,  or  into  a 
difference,  so  far  as  the  patient  is  concerned, 
between  Hfe  and  death. 

A  man,  thirty-eight  years  of  age,  who  had 
suffered  for  two  years  from  diabetes  meUitus,  was 
put  upon  a  diet  of  a  cup  of  coffee  for  breakfast,  a 
basin  of  soup  for  dinner,  and  a  glass  of  milk  and 
barley-water  for  supper  ;  and  this  treatment  being 
maintained  for  some  weeks,  the  specific  gravity  of 
the  urine  fell  from  1040  to  1020,  the  glucose 
diminished  greatly,  and  the  quantity  passed  was 
much  lessened.  After  that  he  was  advised  to  take 
one  meal  daily  of  ordinary  mixed  diet,  with  milk 
for  his  evening  meal,  sometimes  with  an  onion. 
Under  this  diet  he  improved  greatly,  and  lived  for 
several  years,  dying,  however,  in  the  end,  of  the 
remote  effects  of  the  intemperate  habits  to  which 
he  was  formerly  addicted. 

In  another  similar  case,  a  man  improved  greatly 
for  some  weeks  on  a  similar  diet,  and  seemed  to  be 
in  a  fair  way  to  recover,  when  unfortunately  the 
love  of  alcoholic  drink  to  which  he  had  formerly 
been  addicted,  overcame  him,  and  giving  way  to 
alcoholic  intemperance  he  speedily  relapsed  and  died. 
On  the  other  hand,  a  middle-aged  man  suffering 
from  diabetes  mellitus  at  the  same  time  as  the  two 
last-mentioned  persons,  and  who  was  fed,  on  medical 
advice,  on  a  diet  of  milk,  meat  and  eggs,  died  in 
six  months  of  diabetic  coma.     The  view  taken  of 


245 

the  causation  of  his  illness  was  that  it  was  due  to 
too  much  starch  and  sugar  ;  and  the  excess  of  food, 
which  was  most  probably  the  real  cause,  was 
continued  in  a  somewhat  modified  form,  an  excess 
of  mixed  diet  being  replaced  by  an  excess  of 
nitrogenous  food,  and  the  patient  lost  his  life. 
Here  again  a  discussion,  which  sounds  an  academic 
one  only,  between  the  merits  of  too  much  food,  on 
the  one  hand,  and  too  much  starch  and  sugar,  on 
the  other,  or  between  the  general  and  the  particular, 
may,  when  translated  into  treatment,  be  fraught 
with  the  issues  of  life  or  death  to  a  patient. 

In  other  cases  I  have  seen  great  benefit  from 
the  administration  of  half  a  pint  of  milk  at  8  a.m. 
and  4  and  8  p.m.,  with  4  ozs.  of  beef  or  mutton  and 
some  green  vegetables  at  12  noon.  This  is  of 
course  a  greatly  restricted  diet,  whether  as 
measured  by  its  calorie  value  or  by  custom. 
Professor  Davis,  whose  work  on  the  Diet  Treatment 
of  Disease  has  already  been  referred  to,  speaks  of 
' '  a  reasonable  restriction  of  the  diet "  in  the 
condition  in  which  too  much  water  is  being  passed. 

Cases  of  too  great  mentalisation  or  cerebration 
or  of  too  rapid,  and  irregular,  and  flighty  thinking, 
very  often  find  their  way  to  asylums,  and  are 
therefore  not  so  much  treated  by  doctors  outside  of 
these  establishments ;  but  the  forced  and  sometimes 
mechanical  feeding  which  is  often  resorted  to  there 
is  of  very  doubtful  value,  and  seems  frequently  to 
be  over-done.  When  patients  in  these  places  refuse 
food,  as  they  so  often  do,  the  proper  plan,  it  seems 


246 

to  me,  would  be  to  wait  until  they  come  round,  and 
to  refrain  from  interference  until  signs  of  danger  to 
life  set  in,  which  would  generally  be  not  after  a  few 
days,  but  after  the  lapse  of  some  weeks.  I  was 
present  on  one  occasion  at  a  discussion  of  this 
question,  at  the  meeting  of  a  medical  society,  at 
which  several  asylum  experts  were  also  present,  and 
only  one  case  could  be  cited  in  which  a  person  in  an 
asylum  had  carried  starvation  to  actual  death.  All 
the  rest  had  given  it  up  after  some  time,  and  had 
returned  more  or  less  to  food.  Dr.  Dewey,  of 
Meadville,  Pennsylvania,  publishes  a  remarkable 
case  in  which  a  young  lady  in  such  circumstances 
was  induced  to  leave  an  asylum  and  to  put  herself 
under  the  care  of  a  scientific  man  who  believed,  in 
accordance  with  Dr.  Dewey's  teaching,  that  too 
much  food  is  often  the  chief  cause  of  insanity. 
Under  his  advice  she  began  to  fast,  neither  he  nor 
she  knowing  for  how  long  the  experiment  was  to  be 
allowed  to  continue.  He  meant  to  interfere  if  he 
saw  any  danger  of  death  from  direct  starvation. 
He  believed  she  was  insane  from  indirect  starvation, 
otherwise  from  the  effects  of  too  much  food  taken 
too  often,  which  had  so  altered  her  blood  as  to 
supply  the  brain  badly,  and  so  to  cause  the  general 
flightiness  which  compelled  her  friends  to  send  her 
to  an  asylum.  The  well-meant  but  ill-judged  plan 
of  treatment  there  was  to  feed  her  five  times  a  day. 
After  fasting  for  45  days,  during  which  time  she 
took,  besides  water,  no  food  at  all,  she  became 
perfectly  sane,  and  has  since  remained  so,  having 


247 

returned,  of  course,  to  proper  but  not  excessive 
feeding,  meantime.  It  may  also  be  mentioned  that 
from  the  24th  to  the  45th  day  of  the  fast  she 
walked  over  100  miles.  Her  portrait  and  name  are 
published  by  Dr.  Dewey.  On  looking  at  it,  one 
would,  I  think,  say  she  was  "neurotic,"  but  neurotic 
people  may  be  sane  or  insane  according  to  the  ways 
in  Avhich  their  environment  alters,  and  one  of  the 
chief  causes  why  such  persons  not  infrequently  pass 
the  border  line  between  sanity  and  insanity  is,  I 
beheve,  through  the  mismanagement  of  their  food. 
I  feel  quite  sure  that  many  persons,  especially 
women,  are  in  asylums  mainly  through  this  cause, 
and  that  much  of  the  flightiness  of  conduct  and 
hysteria  as  it  is  called,  manifested  by  many  women 
in  conducting  the  business  of  their  lives,  and  that 
of  their  households,  and  who  are  not  in  asylums,  is 
due  to  the  same  cause.  I  have  had  a  most  striking 
proof  of  this  related  to  me  in  a  long  letter,  the 
writer  saying,  after  her  recovery,  that  all  the  while 
that  she  was  behaving  so  strangely  as  to  become 
at  last  quite  intolerable  to  her  friends,  she  knew 
what  was  going  on  and  knew  the  cause  also  (for  she 
had  been  told  what  it  was,  viz.,  an  inordinate 
liking  for  sweets),  but  for  a  long  time  she  could  not 
brace  herself  up  to  do  without  them.  When  at  last 
she  did  so,  however,  and  restrained  her  abnormal 
appetite,  she  again  became  sane  and  quite  her 
former  amiable  and  reasonable  self 

I  do  not  think  that  the  very  potent  influences 
of  causes  of  this  prosaic  kind  in  disturbing  mental 


248 

equilibrium,  especially  in  women,  has  received 
anything  like  adequate  recognition.  If  it  were  to 
receive  it,  much  more  could  be  often  done  by 
very  simple  means  to  restore  patients  to  mental 
health,  and  prevent  the  need  of  their  being  removed 
to  asylums.  If  this  is  so,  we  can  see  how  insanity 
is  often  brought  on  just  as  other  diseases  are,  just 
in  the  same  ways  often  as  an  ordinary  cold  or  sore 
throat  is  induced,  and  how  ridiculous  it  often  is  to 
suppose  that  heredity,  e.g.^  has  any  more  influence 
on  the  disturbance  of  mental  balance  than  it  has  in 
inducing  many  other  ailments.  Further  references 
to  this  point  of  view  will  be  made  later.  For 
the  present,  the  important  point  is  to  notice 
that  patients  shewing  signs  of  flightiness,  and 
loquacity,  and  oddness  in  ordinary  life  outside  of 
asylums,  can  often  be  well  treated  by  a  milk  diet, 
and  frequently  do  so  well  on  it  as  not  to  require 
removal.  But  a  diet  of  two  pints  or  three  pints  of 
milk  a  day  is  a  greatly  restricted  diet.  In  calories 
it  does  not  amount  at  the  highest  estimate  to  more 
than  600  or  900  against  the  2303  calories  emitted 
by  the  starving  man.  Even  six  pints  of  milk  a 
day — and  to  see  how  much  this  amounts  to  (a  glass, 
e.g.,  at  4,  6,  8,  and  10  a.m.,  12  noon  and  2,  4,  6,  8, 
and  10  p.m.,  12  midnight,  and  2  a.m.),  let  anyone 
try  to  keep  ujd  the  ordeal  of  taking  this  quantity 
for  a  week,  and  he  will  find  out  what  an  intolerable 
burden  it  is.  But  even  so,  six  pints  of  milk  a  day 
only  amounts  to  1800  calories,  and  the  starving  man 
emits    2303  !  !     I    knew    a   woman    suffering   from 


249 

typhoid  fever  who  died  from  no  other  cause  than 
stuffing  her  with  milk  at  this  rate.  If  she  had  had 
two  and  a  half  or  three  pints  a  day  she  would 
probably  have  recovered.  I  need  not,  I  think, 
dwell  ftirther  on  the  management  of  excess  of 
function.  It  is  only  another  name  in  most  cases  for 
the  feverish  state,  and  it  is  invariably  and  by 
general  consent,  and  quite  properly,  treated  both 
by  medical  practitioners  and  by  the  public,  by 
restriction  of  diet.  It  is  true  that  illustrations  of 
excess  of  function,  especially  great  excess,  have 
to  be  obtained  from  what  is  usually  termed 
disease,  but  this  only  shews,  what  is  freely 
admitted,  that  healthy  function  shades  off  into  disease 
by  insensible  gradations.  The  practice  of  medicine  is 
only  applied  physiology  and  applied  pathology,  but 
between  physiology  and  pathology  there  are  only 
the  differences  that  are  found  between  function  and 
disease,  viz.,  differences  of  degree.  The  differences 
are  those  which  obtain,  e.g.,  between  day  and 
night,  not  differences  of  kind,  or  quality,  or  essence, 
but  of  degree  only — not  differences  between  con- 
tradictories, but  only  of  contraries. 

I  am  afraid  I  shall  find  much  more  difficulty, 
and  shall  encounter  much  more  opposition  in  the 
attempt  to  establish  the  proposition  that  defect  of 
function  must  also,  in  the  vast  majority  of  cases 
that  come  before  us,  be  treated  by  restriction  and 
not  by  increase  of  the  diet.  Nevertheless,  the 
references  already  made  will  help  us  to  understand 
this  part  of  treatment  better.     Of  course  I  do  not 


250 

deny — let  me  repeat  this — that  defect  of  function 
is  occasionally  due  to  direct  starvation.  In  this 
case  it  must  be  treated  by  cautious  increase  of  food. 
But  this  is  a  comparatively  rare  occurrence  in 
ordinary  practice,  so  rare  that  it  may  practically  be 
put  out  of  account.  The  great  majority  of  cases 
of  defect  of  function  are,  on  the  other  hand,  caused 
by  excess  of  food  (or  of  some  other  stimulus — but 
excess  of  food  is  by  far  the  commonest  form  of 
over-stimulus),  and  must  therefore  be  treated  by 
restriction.  Let  me  deal  with  the  various  functions 
seriatim,  and  in  the  same  order  as  before.  First  as  to 
circulation.  I  saw  a  boy  of  ten  years  of  age,  not  long 
ago,  whose  pulse  rate  was  40  a  minute,  and  the  pulse 
was  also  irregular  (there  was  defect  of  function  and 
also  irregularity  of  function).  He  got  quite  well, 
that  is,  his  pulse  rose  to  80  and  became  quite 
regular  on  a  glass  of  milk  and  barley  water  three 
times  a  day,  or  rather,  on  half  a  glass  of  the 
mixture  given  six  times  a  day,  and  nothing  but 
water  in  the  night.  This  treatment  was  continued 
for  a  fortnight,  when  his  pulse  having  risen  to  80 
and  having  become  regular,  he  was  given  one  meal 
in  the  middle  of  the  day,  and  the  milk  and  barley 
water  continued  to  the  exent  of  half  a  pint  of  the 
mixture  morning  and  evening.  After  about  ten 
days  of  this  treatment,  and  when  the  circulation 
had  become  well  re-established  he  was  given  an 
ordinary  meal  at  tea-time,  and  his  mother  was 
recommended  to  continue  this  diet  for  the  boy  after 
he  went  back  to  school,  that  is,  he  was  to  have  two 


251 

meals  a  day,  dinner  and  tea,  and  a  glass  of  cold 
milk  and  boiling  barley-water,  equal  parts,  in  the 
morning  before  he  went  out.  Similar  treatment, 
but  continued  for  three  or  four  weeks  in  the  first 
stage,  namely,  half  a  glass  of  milk  and  barley-water, 
equal  parts,  every  two  hours  in  the  day,  and 
nothing  but  water  at  night,  raised  the  pulse  of 
a  man  from  38  to  72  a  minute.  After  this  he  was 
treated  as  the  boy  was,  by  cautious  increase  of  the 
diet,  that  is,  he  was  put  first  on  one  meal  a  day,  and 
after  a  couple  of  weeks  on  two  daily  meals,  and 
became  quite  well.  It  will  help  to  avoid  repetition 
if  I  say  here,  that  in  both  of  these  cases  I  recom- 
mended the  continuance  of  two  meals  a  day,  and  of 
two  only,  after  recovery  -  what  may  be  called  a 
dissiteous  regime -on  the  following  grounds.  Too 
much  food  taken  too  often  appeared  to  be  the  chief 
cause  of  the  illness  in  both  cases.  It  was  necessary 
to  greatly  restrict  the  diet  in  order  to  obtain  or  to 
allow  recovery,  and  this  restriction  had  to  be 
carried  to  a  point  below  what  would  have  been 
sufficient  for  the  maintenance  of  life  and  vigour, 
especially  as  all  work  was  perforce  stopped  for 
the  time  being.  But  if,  after  recovery,  the  patients 
had  been  advised  to  return  to  a  diet  as  full  as  that 
on  which  they  had  previously  fallen  ill,  it  is  plain 
that  they  might  be  expected  to  fall  ill  again,  either 
in  the  same  ways  as  before  or  in  some  other  way. 
In  order,  therefore,  to  avoid  this  evil,  they  were 
both  recommended  in  future  to  pursue  a  dissiteous 
regime    in  place  of  the   three  or  four   meal    plan 


252 

(the  trissiteous  or  even  tetrasiteous  plan)  formerly 
pursued,  and  the  results  have  been  very  satisfactory. 
When  defect  of  function  (in  these  two  cases,  too 
great  slowness  of  the  pulse)  shews  itself  from  food 
taken  too  often  or  too  much,  we  may  say  that  there 
is  present  in  the  body  irritation  with  tolerance,  the 
irritation  shewing  its  primary  effect,  viz.,  depression 
or  shrinking.  On  the  other  hand,  when  a  quick 
pulse  is  caused  by  excess  of  food  supply,  we  may 
say  that  there  is  present  irritation  with  intolerance, 
the  irritation  shewing  its  secondary  efiect,  viz., 
reaction  or  swelling.  These  tw^o  states  may  be 
illustrated  by  the  behaviour  of  disciplined  soldiers 
in  attempting  to  get  away  from  danger,  as  compared 
with  the  behaviour  of  an  ungoverned  panic-stricken 
crowd.  When  a  thousand  soldiers  attempt  to  go 
too  quickly  through  a  pass  which  will  allow  only  six 
at  a  time  to  pass,  they  may  become  blocked  and 
slowly  come  to  a  standstill.  But  the  state  of 
irritation  with  intolerance  is  like  a  crowd  of  persons 
flying  from  a  burning  theatre,  jostling  one  another, 
])locking  up  the  doorways,  and  trampling  on  one 
another  in  wild  panic.  If  the  former  ofier  a  rather 
helpless  mark  for  the  attack  of  an  enemy,  the  latter 
not  only  do  this  but  are  their  own  enemy,  and  are 
self-destructive  besides.  In  both  cases,  however, 
the  remedial  indication  is  to  diminish  the  numbers 
attempting  to  pass,  and  to  diminish  the  causes 
that  led  to  the  block  ;  but  there  is  greater  need  for 
haste  to  act  in  the  latter  condition  than  in  the 
former ;  and  the  analogue  of  the  way  in  which  the 


253 

numbers  attempting  to  pass  may  most  certainly  and 
most  safely  be  diminished  in  both  conditions  of  the 
body  is  by  restricting  the  supplies  of  food  which  led 
to    their    multipHcation    or    increase   in   the    first 
instance.     If  these  ideas  are  kept  in  mind  we  easily 
see  how  both  contrary  states  must  be  treated  in  the 
same    way.      Neither   the    boy   nor   the   man    had 
alcoholic    stimulants     administered.       They    might 
have  had,  but  they  did  not.     The  essence  of  the 
treatment  was  the  restriction  of  the  diet.     There  is 
a  long,  low  depressed  state  of  the  circulation  which 
follows   influenza    sometimes,   in    which   the    pulse 
becomes  very  slow  and  sometimes  irregular.     This 
also  ought  to  be  treated  by  the  administration  of 
hot  fluids  and  by  restriction  of  the  diet  in  the  way 
suggested.     When   it    is   not,    but    is    treated    by 
increase  of  the  diet,  as  it  too  often  is,  the  patient 
sometimes  succumbs  to  the  treatment,  while  his  best 
if  not  his  only  chance  would  have  been  from  the 
opposite  method  of  treatment.     How  serious  is  this 
difference  of  view  and  of  treatment  between  different 
medical  expert^  may  be  imagined.     I  feel  convinced 
that  it  forms  a  great  part  of  the  reason  for   the 
low    esteem    in    which  the    medical    profession   is 
frequently   held   by   the  public,   a  low  estimation, 
notwithstanding   the  laudatory  things  they  say  of 
us  when  in  other  moods,  too  often  justified — for  if 
the    experts    are    not    only    not   agreed,    but    are 
actually  in  flagrant  conflict,  what  confidence  can  be 
placed  in  them  ?     Imagine  a  business  expert  called 
in  to    advise  the  community  how  to  mitigate   the 


254 

stagnation  of  business  caused  by  a  plethora  of 
stocks.  If  in  such  a  case  he  should  advise 
increased  manufacture  so  as  to  multiply  the  stocks, 
his  clients  would  feel  that  he  had  misapprehended 
the  problem,  even  if  they  could  not  quite  see  how. 
But  if  another  expert  advised  using  up  the  existing 
stocks  before  proceeding  to  manufacture  new  ones, 
a  long  suffering  public  could  only  feel  that  both 
experts  could  not  be  right,  and  might  be  driven  to 
conclude  that  no  coniSdence  could  be  placed  in 
either,  or  in  the  expert  class  as  a  whole.  And  yet 
one  of  these  experts  would  be  right,  and  the  other 
wrong,  so  that  the  last  conclusion  might  be  very 
unjust. 

2.  The  function  of  Nutrition.  The  next 
function  to  be  considered,  if  we  follow  the  former 
order,  will  be  that  of  nutrition,  in  the  restricted 
sense  in  which  it  may  be  said  to  cause  obesity  and 
attenuation.  (Of  course,  in  a  wider  sense,  nutrition 
may  be  said  to  cover  all  the  functions,  and  changes, 
and  metabolisms  of  the  body).  There  will  be 
no  difference  of  view  that  obesity  must  always  (or 
at  least  almost  always  ?)  be  treated  by  restriction 
of  food  and  drink.  But  attenuation,  or  too  great 
thinness,  and  emaciation — is  this  always  or  is  it 
generally  to  be  treated  by  increase  of  food  ?  Let 
us  see.  The  young  woman  formerly  mentioned 
came  to  me  suffering  from  indigestion,  anaemia,  and 
emaciation.  She  had  been  ill  for  three  years,  and, 
for  the  last  two  years  before  I  saw  her,  had  been 
unable   to   follow    her   very   light  occupation   of  a 


255 

paste-board  box  maker.  (This  occupation  consists 
mostly  in  sitting  with  small  pieces  of  paste-board  in 
the  hands,  and  allowing  a  triangular-shaped  iron, 
driven  by  power,  to  come  down  and  make  "  corners  " 
on  the  paste-board.  It  is  rather  a  monotonous 
occupation,  but  is  in  no  sense  laborious,  so  that  the 
person  who  could  not  do  that  must  have  been  weak 
indeed.  If  ever  any  person  required  to  be  "  fed  up," 
surely  it  would  be  a  person  in  such  a  state,  and, 
indeed,  this  was  exactly  what  the  eight  doctors  she 
had  seen  before  had  advised  her — but  she  was  not 
better,  but  worse).  For  the  first  four  weeks  after 
she  came  to  see  me,  she  took  a  tumblerful  of  milk 
mixed  with  an  equal  quantity  of  boiling  water, 
morning  and  evening,  and  about  half  a  pint  of 
mutton  -  or  chicken  -  soup  in  the  middle  of  the  day. 
I  need  not  go  further  into  particulars  about  this 
case  than  to  say  that  under  this  greatly  restricted 
diet  the  young  woman  gained  1|-  lb.  in  weight  in 
three  weeks.  She  was  suffering  from  the  "starvation 
of  over-repletion,"  and  under  this  restricted  diet 
she  gained  weight.  At  the  very  most  this  diet 
does  not  represent  more  than  450  calories  (probably 
300  calories  is  nearer  its  energy  value),  while  the 
starving  man  emits  energy  value  up  to  2300 
calories.  She  was,  therefore,  under  a  starvation 
diet,  and  under  it  she  gained  weight  !  !  How  ? 
Because  her  tissues  were  too  dense  ;  they  were 
obstipated  or  constipated  (so  was  the  action  of  her 
bowels,  which  slowly  rectified  themselves  under  the 
treatment),  and  the  blood,  which  was  not  deficient 


256 

at  all,  but  in  excess,  could  not  flow  to  the  tissues, 
and  so  could  not  nourish  them  properly,  and  she 
became  pale  and  thin,  and  wasted  and  weak. 
When,  under  a  starvation  diet,  her  body  was 
induced  to  some  extent  to  live  on  itself,  the  tissues 
slowly  began  to  be  less  dense,  the  blood  flowed  into 
them  better  and  nourished  them  better,  and,  as  she 
probably  replaced  some  of  her  too  dense  tissues 
with  water,  which  was  not  restricted,  though  other 
forms  of  food  were,  she  gained  weight.  There  was 
no  difierence  among  the  experts  as  to  the  facts. 
The  girl  was  anaemic,  she  did  suffer  from 
indigestion,  she  was  pale,  and  thin,  and  wasted. 
But  there  was  all  the  difference  in  the  world 
between  the  experts  as  to  the  interpretation  of  the 
facts,  and  there  was  also  the  greatest  difference  in 
the  results  of  treatment  founded  on  the  different 
and  opposing  views  held  by  the  experts.  This  kind 
of  case  can  be  parallelled  every  day  in  practice. 
Another  illustration  of  increase  of  weight  following 
restriction  of  the  diet  will  be  found  in  the  case 
detailed  in  the  next  chapter,  where  a  child  of  four 
years  of  age  gained  9  lbs.  in  weight,  on  a  diet 
described  by  physiologists  as  a  starvation  diet, 
continued,  not  as  in  the  case  referred  to,  for  a  short 
time,  but  for  the  long  period  of  fifteen  months. 
What  evidence  could  be  more  striking  or  more 
convincing  to  the  candid  inquirer  than  this  sort  of 
evidence  ?  Truly  they  who  do  not  yield  assent 
to  it  will  not  be  convinced  by  anything. 

3.     Kespiration.      There   is    a    phase    of    the 


257 

respiration  in  which  the  breathing  becomes  very- 
slow,  with  long  pauses  in  between.  Instead  of 
breathing  fourteen  or  fifteen  times  a  minute,  a 
person  will  breathe  only  eight  or  even  six  times  a 
minute,  three  or  four  breaths  taking  place  quickly 
after  one  another,  after  which  a  long  pause 
occurs,  lasting  in  some  cases  for  half  a  minute,  to  be 
followed  by  three  or  four  more  quick  breaths,  and 
then  another  half-minute  pause.  The  breathing  is 
not  only  slow,  but  irregular,  though  it  is  often,  as 
will  be  seen,  regular  in  its  irregularity.  In  this 
condition  the  state  of  the  patient  is  generally  very 
serious — in  fact,  very  often  this  condition  precedes 
death — so  that  in  general  nothing  which  we  can  do 
is  of  any  avail  to  lift  him  out  of  his  state  of 
too  slow  breathing.  Nevertheless,  under  the  ad- 
ministration of  hot  drinks,  whose  aggregate  calorie 
value  in  twenty-four  hours  does  not  amount  to 
more  than  400  or  even  less,  this  slowness  and 
irregularity  of  breathing  sometimes  quickens,  and 
becomes  more  regular,  and  patients  survive  for  a 
time,  till  another  attack  comes  on.  There  will 
probably  be  no  difference  of  opinion  as  to  the 
treatment  to  be  adopted  for  such  a  condition.  No 
doctor  that  I  have  ever  heard  of  would  advise 
the  administration  of  much  food  or  of  solid  food  in 
such  a  condition,  though  he  might  [term  the 
frequent  administration  of  small  quantities  of  fluid 
"  keeping  up  or  nourishing  "  his  patient.  It  sounds 
better  to  the  ears  of  the  friends  to  term  it  so.  But 
scientifically,  so  far  as  the  calorie  value  of  such  a 
Q 


258 

diet  is  concerned,  it  is  a  restrictive  diet,  and  not  a 
' '  nourishing "  one.  Therefore  I  conclude  that 
depression  of  the  respiratory  function  is  treated  by 
common  consent,  and  ought  to  be  treated  in  the 
vast  majority  of  cases  by  restriction,  and  not 
by  increase  of  the  diet.  Of  course,  if  slowing 
and  irregularity  of  the  respiration  had  occurred 
among  Mark  Twain's  men  exposed  in  the  boat, 
and  if  it  had,  therefore,  been  due  to  direct 
starvation,  as  it  might  have  been,  it  would  have 
been  necessary  to  treat  it  by  cautious  increase  of 
food — but  this  is  the  uncommon  or  exceptional  case, 
while  the  other  is  the  common  one.  It  is  hardly 
necessary  to  say  that  too  great  rapidity  of  the 
respiration  is  by  universal  consent  and  quite 
properly  treated  by  restriction  of  the  diet.  It  is 
in  fact  one  of  the  most  striking  marks  of  the  feverish 
state,  which  is  always  treated  by  restriction. 

4.  Kenal  Action.  Defect  of  this  function  or 
scanty  urination  usually  depends  on  over-nutrition, 
and  ought,  therefore,  to  be  treated  by  restriction 
of  the  diet.  I  think  I  need  not  dwell  much  on 
this  view  because  it  is  a  generally  accepted  canon 
of  treatment  that  scanty  urination,  as  it  is  usually  a 
mark  of  the  feverish  state,  must  be  treated  by 
restriction  of  the  diet.  But  it  is  a  curious  thing, 
shewing  how  far,  as  yet,  medical  treatment  is  from 
being ,  as  it  ought  to  be,  a  set  of  examples  of  applied 
physiology,  that  opinions  as  to  treatment  still 
differ,  not  as  to  defect  of  the  renal  function,  but  a& 
to  its   excess.     It   is,   as  we   have  seen,  quite   tha 


259 

reverse  in  the  case  of  the  three  functions  akeady 
considered.  In  these  there  are  differences  of  view 
as  to  how  deficiency  ought  to  be  treated,  but  none 
as  to  excess.  If  we  think  about  it,  however,  we 
shaU  see  that  a  scanty,  high  coloured,  and  loaded 
urine  indicates  a  plugged  or  blocked  renal  action, 
corresponding  with  the  ordinary  form  of  con- 
stipation of  the  bowels,  while  diabetes,  with  or 
without  the  presence  of  sugar  (diabetes  means 
free  urination,  from  Sta  and  jSaCvo),  =  I  pass 
through),  indicates  the  excessive  renal  action  which 
corresponds  with  long  continued  diarrhoea.  As 
constipation  and  diarrhoea  are  both  generally  caused 
by  excess  of  food,  and  as  they  must  both,  therefore, 
be  generally  treated  by  restriction  of  the  diet,  we 
can  the  more  readily  see  how  the  same  canons  of 
treatment  should  govern  the  management  of  the 
renal  function  in  opposite  conditions,  and  we  can 
the  more  easily  understand  the  rationale  as  well  as 
the  efficacy  of  the  treatment  of  the  cases  of 
diabetes  already  detailed  in  this  chapter. 

5.  The  Bodily  Temperature.  A  low  temper- 
ature ought  also  to  be  generally  treated  by  restriction 
of  the  diet.  No  doubt  in  direct  starvation  the 
temperature  falls,  and  where  a  low  bodily  temper- 
ature of  say  95°  or  96°  F.  is  caused  in  this  way, 
it  must  be  treated,  if  we  have  any  opportunity  of 
treating  it  at  all,  by  cautious  increase  of  the  diet. 
But  the  commonest  cause  of  subnormal  temperature  is 
not  deficiency  of  food,  but  excess  of  it  ;  and  equally 
obviously  this  must  be  treated  by  restriction  of  the 

92 


260 

diet.     A  great  difficulty  in  accepting  this  view,  a 
difficulty   so    great    that   it   seems   to  render   the 
defence   of  the  view  absurd  to  common   sense,    is 
that  persons  suffering  in  this  way  are  often  thin, 
emaciated,  and  attenuated  by  their  illness,  and  it 
seems    ridiculous    to    advise    restriction.     In   fact, 
persons  no  doubt   often   become   very   angry,    and 
change     their     medical     adviser,      if     he     advises 
restriction  in  this  condition.     And  if  they  do  not, 
their  friends  do  it  for  them.    To  meet  this  difficulty, 
the  medical  adviser  is  often  compelled  to  call  his 
method  by  the  name  of  frequent  and   nourishing 
feeding,  and  in  order  to  seem  to  justify  this,  he  orders 
small  quantities  of  hot  stimulating  fluid  food  (not 
necessarily  alcoholic  stimulants),  at  short  intervals 
of  time.     A  tablespoonful  of  milk  and  hot  barley 
water  every  half  hour,  or  the  same  quantity  or  even 
double  the  quantity  of  the  same,  or  of  hot  beef  tea, 
or  bovril,  or  some  such  food,   taken  all  day   long, 
sounds  as  if  it  were  a  large  quantity  of  nourishing 
food.     In   point   of    fact   it    is  not.     It    is   a   very 
restricted  diet.     Suppose  that  a  patient  takes  an 
ounce  of  milk  and  hot  barley  water  every  half  hour 
from  say  8  a.m.  till  10  p.m.      How  much  does  she 
take  in  a  day  ?     Two  ounces  an  hour  for   14  hours, 
or  28  ounces  in  a  day.     Even  on   the   assumption 
that  the  barley  water  is  as  valuable  a  nutrient  as 
the  milk,  the  total  calorie  value  of   such  a  diet  is 
not  above  450  calories  (it  is  probably  not  so  much 
as  that),  and  we  have  seen  that  the  starving  man 
emits  a  value  of  2300  calories.     But  people  are  so 


261 

easily  led  by  words  that  they  dismiss  the  medical 
adviser  who  speaks  of  restriction — which  such  a  diet 
really  is — and  send  for  him  who  calls  the  same 
thing  a  "  highly  nourishing  diet."  In  point  of  fact 
I  raised  the  temperature  of  a  man  who  was, 
besides,  thin,  emaciated,  and  attenuated  by 
constant  vomiting,  lasting  for  seven  years,  from 
96°  F.  to  98*4°,  by  advising  him  to  fast  for  35  days. 
On  the  28th  day  his  temperature  had  risen  to 
normal,  and  remained  so.  I  do  not  think  it  could 
have  been  raised  in  any  other  way.  Neither  does 
he.  He  also  was  very  angry  when  the  suggestion 
was  made  to  him ;  it  seemed  so  much  opposed  to 
reason  and  common  sense ;  and  it  was  only  when  he 
felt  that  he  was  dying  on  the  other  plan  of  frequent 
feeding,  and  when  he  reflected  that  he  might  as 
well  die  on  one  plan  as  on  another,  that  he 
consented  to  submit  to  treatment.  I  believe 
myself  that  he  was  dying  on  the  other  plan,  and 
that  the  method  of  treatment  that  saved  him  was 
the  only  one  that  would  have  done  it.  Or  at  least 
I  believe — what  alone  I  am  concerned  to  make  out — 
that  restriction  of  the  diet  was  indicated  in  the 
treatment  of  the  case.  How  much  restriction  was 
necessary,  and  whether  absolute  starvation,  except 
for  the  free  use  of  water,  for  five  weeks  was 
necessary,  must  be  left  to  the  opinion  of  the 
medical  adviser.  But  the  thin,  emaciated  man, 
though  he  lost  some  13  lbs.  more  weight  during 
the  fast,  not  only  did  not  die  of  it,  but  recovered ; 
and  during  the   time  of  the  treatment  his  bodily 


262 

temperature  rose  over  2°  F,  (I  believe  it  rose  3"  F., 
but  say  over  2°  F.,  because  I  wish  to  keep  within 
the  bounds  of  fact).  Could  anything  have  demon- 
strated more  clearly  what  the  cause  of  the  man's 
illness  was,  and  what  the  cause  of  his  subnormal 
temperature  was,  than  his  behaviour  under  the 
treatment?  In  seven  years  a  man  has  many 
opportunities  of  knowing  his  condition  and  of 
hearing  the  views  of  different  advisers.  And  his 
unwillingness  to  submit  to  treatment  makes  him 
all  the  more  valuable  a  witness  to  its  efficacy,  after 
he  has  submitted. 

6.  Defective  Cerebration.  This  condition  also, 
as  usually  met  with,  is  due  not  to  too  little  food  but 
to  too  much,  and  generally  requires  restriction  of 
the  diet.  Of  course,  here  also  the  cause  may  be 
long  continued  and  direct  starvation.  In  this 
unusual  case  it  must  be  treated  by  cautious  increase 
of  the  diet.  The  history  of  the  case  alone  will 
determine  which  is  the  cause,  but  in  ordinary 
practice  the  cause  is  so  seldom  deficiency  of  food 
that  it  may  practically  be  left  out  of  account.  I 
have  already  said  something  about  this  condition  at 
pp.  246-7,  and  must  refer  the  reader  to  what  is  there 
said,  for  my  defence  of  the  opinion  that,  the  cause 
being  generally  too  frequent  feeding  and  its  con- 
sequences, the  condition  calls  for  restriction  of  the 
diet.  I  have  seen  some  very  notable  cases  in  which 
this  was  true,  and  in  which  also  the  opposite  line  of 
treatment  was  very  damaging  to  the  patient.  This 
kind   of    case,    however,    as   it   leads    so    often   to 


263 

deprivation  of  liberty,  and  stirs  up,  besides,  fierce 
passion  because  of  the  horror,  the  altogether  foolish 
horror  which  persons  have  of  having  their  friends 
confined  in  asylums  because  of  their  prejudices 
regarding  heredity,  cannot  be  so  fully  entered  into 
or  described  as  some  others.  If  it  were  generally 
realised  that  brain  irritation — both  the  irritation 
with  reaction  or  intolerance,  as  I  have  called  it,  and 
the  brain  irritation  with  tolerance,  which  shews  itself 
in  depression — is  very  often  caused  in  just  the  same 
ways  as  the  taking  of  any  other  illness,  then  we 
might  be  allowed  to  talk  more  calmly  and  dis- 
passionately about  it.  When  dealing  with  the 
subject  of  the  heredity  of  disease,  and  when 
attempting  to  distinguish  between  the  organisation 
with  its  qualities,  which  is  generally  transmitted, 
and  acquired  disease  itself,  which  is  generally  nof 
transmitted,  I  hope  to  return  to  this  point.  Mean- 
time, I  think  it  will  be  well  to  close  the  general 
discussion,  as  also  to  refrain  from  considering 
some  other  functional  changes  which  may  occur 
to  the  imagination  of  the  reader,  but  which  are 
unsuitable  for  public  consideration.  One  point  I 
should  mention  about  these  mental  conditions,  viz., 
this  :  both  excess  of  cerebration  and  defect  of  it 
(as  well  as  irregularity)  are  not  infrequently 
caused  by  mental  anxiety  and  stress ;  while 
wrong  feeding,  and  especially  too  frequent  feeding 
frequently  acts  as  a  contributory  cause.  Still  it 
has  to  be  admitted  that  long  continued  anxiety 
alone   may   upset   the    mental    balance.      In   fact, 


264 

however  a  man  or  woman  lives  in  respect  of  his  diet, 
he  may  be  over-borne,  and  his  mental  balance  upset, 
by  anxieties  of  business  and  of  domestic  and  social 
circumstances  too  great  to  withstand.  Anxiety  is 
no  exception  to  the  general  rule  that  moderation 
is  the  only  fixed  and  the  only  unfailing  rule ; 
but,  although  without  the  stimulus  of  moderate 
anxiety,  we  may  tend  to  become  lethargic  and 
unwilling  for  exertion,  still  under  too  much  pressure 
we  may  lose  our  balance  altogether,  and  drop  into 
melancholic  depression  on  the  one  hand,  or  react 
into  maniacal  excitement  on  the  other. 

I  think,  however,  as  the  result  of  this  long 
discussion,  that  I  have  been  able  to  shew  the  two 
paradoxes  in  action,  viz.,  first,  the  paradox  that  the 
same  causes  induce  opposite  states  in  the  body,  and, 
second,  that  opposite  causes  induce  the  same  state. 
And  I  think  I  have  also  shewn,  or,  at  least,  have 
rendered  it  very  probable,  that  of  all  causes  food 
is  the  most  important,  so  that  in  finding  ourselves, 
called  on  to  treat  excess  of  function,  defect  of 
function,  or  irregularity  of  function,  we  should 
eliminate  the  eff'ects  of  food  in  causing  the  condition 
before  we  proceed  further  in  search  of  causes.  Our 
view  as  to  causation  may  or  may  not  afiect  our 
treatment  of  cases  (although  it  generally  does, 
whether  we  know  it  or  not),  but  the  prevention  of 
diseases  is  so  wholly  dependent  on  our  ideas  as  to« 
causation,  that  it  is  absolutely  necessary  for  us  tO' 
make  up  our  minds  on  it  if  we  wish  to  prevent 
them. 


265 


CHAPTER  Yin. 


The  Quantity  and  Quality  of  Food  Required  by 
Man.  The  Number  of  Meals,  and  the 
Intervals  of  Time  that  Ought  to  Elapse 
between  Them. 


T  HAVE  already  said  that  the  function  of  food  is 
to  make  blood,  and  that  it  is  only  by  ellipsis 
that  the  function  of  food  can  be  described  as  being 
to  nourish  the  body,  to  supply  energy  to  the  body, 
to  maintain  its  structure  and  tissues,  and  to 
provide  for  their  repair.  It  does  all  these  things, 
no  doubt,  but  indirectly,  by  supplying  material  to 
form  blood ;  and  it  is  directly  the  function  of  the 
blood  to  do  all  these  things,  and  only  indirectly 
the  function  of  the  food  to  do  them.  This  being 
so,  the  question  before  us  in  this  chapter  is  how 
much  food  must  be  daily  taken  into  the  body  of  an 
average  man  or  woman,  in  order  that  the  blood 
may  be  so  made,  and  enriched,  and  refreshed,  as  to 
suffice  to  nourish  the  body  properly,  and  so  as  to 
supply  the  material  whose  oxidation  or  combustion 
may  be  convertible  into  energy  or  work  done,  and 
to  maintain  the  bodily  heat ;  as  also  that  proper 
maintenance  and  repair  of  the  tissues  may  be 
efiected.  An  additional  question  has  also  incident- 
ally arisen  through  discussions  in  previous  chapters, 


266 

and  we  want  to  know  also  how  food  and  blood  may 
do  all  these  things  without  letting  the  bodily 
functions  be  checked  by  too  little  on  the  one  hand, 
or  clogged  on  the  other  by  too  much ;  since  we 
have  seen  that  in  both  of  these  states  the  bodily 
functions  are  impaired  and  rendered  inefficient,  and 
that,  if  either  the  checking  or  the  clogging 
processes  are  pushed,  the  bodily  functions  are  either 
stimulated  to  great  excess  of  action,  or  tend  to 
come  to  a  stand-still.  A  great  deal  of  discussion 
has  always  taken  place  around  this  question  of  food- 
supply  to  the  body ;  and  there  are  commonplaces  in 
inference  and  in  observation  which  have  naturally 
occurred  to  inquirers  in  all  times,  as  well  to  ancient 
writers  on  the  subject  as  to  the  modern  ones,  who, 
since  the  time  of  Liebig,  have  considered  the 
chemical  composition  of  food,  and  who,  since  the 
time  of  Count  E-umford  and  Joule,  have  been  put  on 
the  track  of  considering  the  mechanical  equivalent 
of  heat,  and  its  conversion,  by  mechanical  and 
animal  machines,  into  physical  and  physiological 
work. 

I  have  already  at  pages  140-2  mentioned  three 
important  observations  made  by  the  ancient  Greek 
medical  authors,  which  have  a  bearing  on  this 
subject,  and  need  not  repeat  them  here.  But  it 
would  obviate  a  good  deal  of  needless  labour  if 
persons  who  have  proposals  to  make  on  this  and 
cognate  subjects  would  familiarise  themselves  with 
what  has  already  been  said  and  done  in  these 
matters.     Even    the   distinguished    physician,    who 


267 

has  re-introduced  the  no  breakfast  plan  as  a 
practical  proposal  for  the  circumstances  of  to-day, 
introduces  his  ideas  in  the  following  words  : — "  A 
hygiene  that  claims  to  be  new,  and  of  the  greatest 
practicability,  and  certainly  revolutionary  in  its 
application,  would  seem  to  require  something  of  its 
origin  and  development,  to  excite  the  interest  of 
the  intelligent  reader."  But,  as  we  have  seen,  the 
advice  is  not  new  and  revolutionary.  So  far  from 
being  either  of  these,  indeed,  it  does  not  go  so  far 
as  the  ancient  writer  in  its  recommendation,  since 
Dr.  Dewey  does  not  recommend  the  taking  of  less 
than  two  daily  meals  generally,  while  the  advice  of 
Hippocrates  to  go  di^apto-ro?  was  offered  to  persons 
who  were  taking  apLorrov  and  hexTrvov  only,  and 
therefore  amounted  to  a  recommendation  that  they 
should  be  monositeous  and  eat  once  a  day  only. 
There  would  or  might  be  less  objection  to  Dr. 
Dewey's  proposals  on  the  part  of  critics  if  they  had 
taken  the  trouble  to  inquire  what  no  less  an 
authority  than  the  father  of  Greek  medicine  himself 
had  said  on  the  subject,  and  if  they  realised  that  it 
is  only  a  very  ancient  advice  resuscitated,  and  that 
very  much  is  to  be  said  for  it,  which  it  would  be 
well  for  them  to  consider. 

The  reader  will  long  before  now  have  gathered, 
I  hope,  that  the  writer  of  this  essay  is  of  opinion 
that  humanity  suffers  far  more  from  being  clogged 
by  too  much  food  than  it  does  from  being  checked 
by  too  Httle.  If  there  are  a  few  people  still  in 
this  country  who  suffer  from  direct  starvation,  there 


268 

are  vastly  larger  numbers,  he  believes,  who  suffer 
from  the  starvation  of  over-repletion.  It  is  not  the 
poverty  of  England  at  the  present  time  which  is 
doing  it  harm  ;  it  is  its  wealth.  Perhaps  this  is  not 
quite  a  fair  statement  ;  and  we  ought  rather  to  say, 
since  neither  wealth  nor  poverty  does  us  harm  in 
itself,  that  it  is  the  use  we  make  of  either  of  them 
which  affects  us  well  or  ill.  The  present  writer  at 
least  believes  that  if  the  effects  of  over-feeding 
were  eliminated  from  medical  practice,  only  a  small 
remnant  of  diseases  would  be  left.  What  remnant  ? 
Perhaps  a  quarter  or  a  third  at  the  outside ; 
perhaps  a  tenth  on  the  least  calculation.  That  is  to 
say,  he  has  come  to  the  conclusion  that  if  people 
generally  would  reform  their  diet — which  means  in 
general  terms,  if  they  would  consent  to  reduce  their 
diet,  for  he  does  not  think  that  it  is  this,  that,  or 
the  other  article  of  food  that  is  doing  damage,  but 
it  is  eating  (and  drinking)  too  often  and  too 
much — if  they  would  reduce  their  diet,  young, 
middle-aged,  and  old  alike,  the  illnesses  that  affect 
humanity  would  fall  by  from  nine-tenths  to  three- 
(juarters  or  two-thirds  as  compared  with  those  from 
which  humanity  now  suffers.  There  would  not  be 
more  than  a  third  or  a  fourth,  perhaps  not  even 
more  than  a  tenth  part  of  them  left  to  trouble  us. 
The  remarks  made  about  the  two  great  medical 
paradoxes  have,  he  hopes,  somewhat  confirmed  this 
view,  and  have  enabled  the  reader  to  understand 
how  the  attenuation  due  to  the  clogging  or  choking 
by  too  much  food  can  easily  be  mistaken,  and  often 


269 

is  mistaken,  even  by  the  experts,  for  the  checking 
which  is  due  to  too  little.  In  other  words,  he 
hopes  he  has  somewhat  cleared  up  the  fallacy  of 
confusing  the  effects  of  direct  starvation  (from  too 
little  food  too  seldom  administered),  with  those  of 
indirect  starvation  (from  too  much  food  taken  too 
often). 

With  these  conclusions  in  our  minds,  let  us 
now  shortly  view  the  present  position  of  the 
question  of  food  supply  to  the  body.  An  immense 
amount  of  work,  by  very  well  informed  and  very 
capable  men,  has  been  put  into  the  question.  Two 
defects,  however,  it  seems  to  the  writer,  char- 
acterise the  whole  of  this  work.  First  :  in  order  to 
determine  the  quantity  of  food  required  for  the 
nourishment  of  the  human  body,  the  quantity  of 
the  egesta  from  kidneys,  bowels,  lungs,  and  skin, 
has  been  computed  over  a  large  number  of 
instances.  It  has  been  found  that  about  twenty 
grams  of  nitrogen,  and  about  300  grams  of  carbon 
are  eliminated  daily  by  the  body  of  the  average 
man  ;  and  hence  it  has  been  computed  that  these 
amounts  must  be  supplied  daily  in  the  food 
administered,  since  nothing  is  more  certain  (there 
can  indeed  be  no  dispute  about  this  point)  than 
that  the  body  can  create  nothing,  and  that,  if  it  is 
not  supplied  with  materials  to  make  good  its  losses, 
it  must  waste  and  consume  away  before  its  time. 
But  what  if  the  average  man  is  in  the  habit  of 
consuming  more  food  than  is  good  for  him  ?  Will 
not  the  egesta  in  this  case   be  larger  than  if    he 


270 

takes  only  a  proper  amount  of  nutriment  ?  Of 
course  they  will.  And  if  from  the  egesta  of  too 
much  food  habitually  taken,  we  infer  the  proper 
amount  of  food  required  to  keep  a  man  in  health, 
shall  we  not  be  apt  to  prescribe  more  for  him  than 
he  requires,  and  so,  by  our  prescription,  choke 
the  functions  of  his  body  with  too  much,  and 
so  lower  his  vitality  by  this  means  ?  Evidently 
we  shall.  What  should  we  think  of  the  engineer 
or  the  stoker  who  should  gauge  the  quantity 
of  coal  required  by  his  engine  by  the  quantity 
of  ash  left  after  combustion  ?  Plainly  the 
quantity  of  ash  left  is  directly  proportional  to 
the  quantity  of  fuel  put  into  the  furnace,  and 
also  inversely  as  the  effectiveness  of  the  com- 
bustion, for  every  stoker  knows  (even  if  he  has 
not  put  his  knowledge  into  words),  that  he  can 
easily  put  his  fire  out  by  heaping  on  too  much  fuel. 
No ;  the  proper  inquiries  for  the  engineer  are  to  ask 
how  much  heat  he  requires  to  provide  for  the 
performance  of  a  certain  amount  of  mechanical 
work,  how  much  heat  he  can  get  out  of  the 
complete  oxidation  of  a  certain  weighed  quantity  of 
fuel,  and  therefore  how  much  fuel  he  requires  to 
consume  before  his  engine  can  do  the  amount  of 
mechanical  work  (or  of  heating)  required  of  it. 
The  questions  asked  by  the  animal  physiologist  and 
by  the  doctors  are  precisely  analogous  ;  and  if  they 
gauge  the  amount  and  frequency  of  administration 
of  food  by  the  quantities  of  carbon  and  of  nitrogen 
eliminated  by  the  body,   they  will  be  very  apt   to 


271 

fall  into  fallacies  of  reply  just  as  would  the 
engineer.  Now  this  is  exactly  what  has  happened 
in  this  enquiry.  When  we  look  at  the  arguments 
of  the  present  physiological  authorities  on  this 
subject,  the  force  of  this  fallacy  becomes  apparent. 

Another  fallacy  incidental  to  this  question  has 
been  that  the  inquiry  how  much  food  is  required  by 
the  body  has  not  been  made  over  a  long  enough 
time,  and  in  particular  that  no  sufficient  enquiry  has 
been  made  whether  the  man  remained  well  or 
became  ill  under  the  administration  of  food.  It  is 
true  that  in  prisons  and  among  soldiers  and  sailors 
some  enquiry  has  been  made  into  this  question,  but 
hardly  any  has  been  made  into  it  as  regards  the 
general  population.  But  to  refrain  from  doing  this 
is  really  to  fall  into  a  very  great  fallacy.  A  man  or 
woman  may  undoubtedly  take  for  a  day  or  two,  or 
for  a  week  or  two,  or  longer,  a  quantity  of  food 
quite  unsuitable  to  health,  either  in  amount  or 
quality,  without  seeming  to  suffer  much  in  one  way 
or  another  ;  and  yet,  if  he  goes  on  doing  so,  may 
suffer  from  illness  from  the  continuance  of  its 
effects.  It  seems  to  me,  I  must  say,  that  the 
frequent  illnesses  from  which  humanity  suffers  offer 
a  prima  facie  case  for  the  suggestion  that  the  way 
in  which  we  live  is  somehow  unsuitable  to  us ;  and 
as  by  far  the  most  important  means  by  which  the 
blood  and  tissues  are  modified  is  through  the  food 
consumed,  the  suspicion  seems  to  arise  in  our  minds 
that  all  may  not  be  well  with  the  ways  in  which  the 
body  is  managed  in  regard  to  this.     When  we  come 


272 


to  inquire  further,  and  in  greater  detail,  as  to  this, 
our  suspicions  become  confirmed,  and  the  answer 
seems  to  arise  in  by  no  means  inaudible  tones  that 
our  food  habits  will  require  much  modification  if  we 
are  to  be  or  to  remain  well.  "We  habitually  eat 
more,"  says  Professor  Nathan  S.  Davis,  of  Chicago, 
"  than  is  needed  to  supply  waste."  All  authorities 
more  or  less  agree  in  this  opinion.  But  what  the 
writer  thinks  has  not  been  sufficiently  realised  is 
that  habitually  to  eat  more  than  is  needed  to  supply 
waste,  translates  itself  and  must  translate  itself  in 
the  conduct  of  life,  into  suffering  from  a  large 
variety  of  illnesses,  and  that  until  this  cause  of 
illness  has  been  eliminated  we  must  continue  to 
suffer  in  these  ways,  whatever  our  doctors  do  for 
us,  and  however  expert  they  may  become  in  finding 
remedies  for  the  relief  of  ailments  brought  on  by 
this  cause.  Another  consideration  brought  out  by 
this  line  of  reflection  is  that  a  constant  succession  of 
illnesses  means  early  senility  and  early  death,  even 
when  patients  recover  from  illness  after  illness,  since 
it  cannot  be  denied  that  the  body  is  weakened  by  a 
succession  of  illnesses ;  and  that  although  Nature 
is  very  skilful  in  eliminating  waste  effete  materials 
from  the  blood  and  tissues  by  the  recurrence  of  the 
illnesses  which  she  inflicts  on  the  body,  still  not  all 
of  the  materies  morbi  or  materies  morhorum  is 
eliminated  each  time,  some  remaining  to  clog  and 
choke  up  the  processes  of  the  body,  so  as  to  bring  it 
into  the  heaviness  and  ineffectiveness  of  old  age, 
and  even  to  death,  much  before  its  time.     And  as. 


273 

after  recovery  from  each  attack,  the  fornier  methods 
of  living  are  again  resorted  to,  and  as,  under  the 
plea  that  a  larger  supply  of  nutriment  is  necessary 
to  restore  the  strength  lowered  by  the  illness  (to 
some  extent  a  true  and  just  plea,  but  apt  to  be 
greatly  overdone),  even  more  nutriment  is  adminis- 
tered than  before,  the  train  of  causes  is  efficiently 
laid  for  the  onset  of  another  attack,  which  occurs 
accordingly,  being  followed  in  turn  by  another 
attack,  and  still  another.  It  is  in  this  way,  and  for 
this  reason,  that,  for  example,  we  hear  of  persons 
having  a  long  succession,  one  after  the  other,  of  severe 
colds,  or  of  their  having  six  or  eight  or  ten,  or  even 
occasionally  fifteen  or  sixteen,  or  even  more,  attacks 
of  influenza,  this  condition  of  constantly  recurring 
illness  not  being  confined  even  to  the  laity,  but 
occasionally  affecting  medical  practitioners  them- 
selves. We  have  already  seen,  even  although  it  is 
lengthening  a  little,  how  unsatisfactorily  short  life 
is  for  the  large  majority  of  the  human  race  living 
under  the  ordinary  conditions  of  civilisation  in  a 
settled  country  like  England.  A  return  of  the 
Manchester  Unity  of  Oddfellows,  recently  made  by 
Mr.  Alfred  W.  Watson,  one  of  the  actuaries  of  the 
society,  has  brought  out  the  general  facts  that  the 
duration  of  life  is  increasing  among  the  members  of 
the  society,  but  that  it  is  accompanied  by  a  larger 
amount  of  sickness  than  formerly.  The  return 
covers  the  years  1893-7,  and  comprises  a  much  larger 
number  of  years  of  life  exposed  to  risk,  and  also  a 
much  larger  number  of  sickness-weeks  than  has  been 


274 

dealt  with  before.  The  general  results  seem  to  be 
these  :  There  has  been  an  increased  sickness  among 
members  aged  17-45  years,  as  compared  with 
1866-70,  of  21  per  cent.  ;  between  the  ages  of 
45  to  65  years  there  is  an  excess  of  sickness  equal 
to  26  per  cent.  ;  and  from  the  age  of  65  and  over 
there  is  an  increase  of  42  per  cent.  As  to  mortality 
there  has  been  an  improvement  as  compared  with 
the  results  of  thirty  years  ago.  Up  to  45  years  of 
age  the  death-rate  now  is  only  two-thirds  of  what 
it  was  thirty  years  ago.  This  is  what  our  general 
examination  of  the  subject  had  already  led  us  to 
expect.  From  45  to  65  years  the  death-rate  has 
been  found  to  be  nine-tenths  of  what  it  formerly 
was.  At  ages  beyond  this  we  find  a  heavier  death- 
rate.  Whatever  the  causes  of  these  general  results 
are,  it  does  not  seem  to  be  very  satisfactory  to 
contemplate  an  improvement  in  the  duration  of  the 
life  of  working  people  up  to  65  years  of  age,  when 
it  is  accompanied  by  a  considerable  increase  in 
sickness.  More  life  and  more  efl&cient  is  what  we 
want,  not  more  life  and  less  efiicient.  Over  65 
years  of  age,  among  this  large  class  of  workpeople, 
both  the  mortality  and  the  sickness  rates  are  larger. 
The  improvement  in  early  life  is  due,  I  suppose,  to 
the  diminution  in  the  fevers  and  in  consumption 
which  have  occurred  in  the  thirty  years  ending  in 
1897,  these  being,  as  we  have  seen,  diseases  whose 
incidence  mainly  falls  in  the  earlier  years  of  life. 
The  benefit  has  been  gained,  as  we  have  seen,  by 
the  attention  which  has  been  paid  to  the  improve- 


275 

ments  effected  between  the  body  and  air,  and  the 
improvement  holds  on  to  a  period  well  past  middle 
life.  What  the  subsequent  deterioration  is  caused 
by  is  not  apparent.  Of  course  if  persons  live 
longer  than  formerly,  they  must  die  at  somewhat 
increased  rates  at  the  later  ages,  since  they  cannot 
go  on  living  indefinitely.  But  whether  this 
accounts  for  the  whole  of  the  increase,  I  do  not 
know.  Evidently,  however,  the  increased  mor- 
tality at  the  later  ages  cannot  be  caused  by 
either  increased  hard  work  or  increased  liability  to 
accident,  since  the  increased  use  of  machinery  has 
tended  to  displace  laborious  hand-work  by  the  lighter 
work  of  superintending  the  machines  which  do  the 
work  ;  while  the  efforts  of  the  legislature  to  prevent 
accidents  have  been  so  far  successful  that  there  is  at 
least  no  increase  of  mortality  or  of  sickness  on  this 
score.  Whether  the  deterioration  of  health  at  the 
higher  ages  is  due  to  the  increased  number  of  meals 
which  working  people,  as  well  as  other  people,  are 
now  taking,  is  at  least  a  question  worthy  of 
consideration. 

Let  us  now  hear  what  different  physiological 
and   other   authorities   say   regarding  the  require- 
ments of  the  body  as  to  food  supply. 

With   a   body   weighing   74    kilogrammes,    or 
about  1 64  pounds,  Ranke  found  himself  sufficiently 
nourished  with — 

Proteids     ...  ...  ...     100  grammes. 

Fats  ...  ...  ...     100 

Carbo-hydrates  ...  ...     240  ,, 

R2 


276 


This  he  could  have  got  from- 


Proteida.     Fat.    Carbohydrates). 
Grams.  Grams.         Grams. 


Lean  meat,  9  ounces,  or  250  grammes, 

containing      ...  ...  ...      55      8*5  0 

Bread,    18   ounces, 

containing      ...  ...  ...      40      7 '5         245 

Butter,    2    ounces, 


containing 


or   500  grammes 
or    55   grammes 


0    55-0 


Fat,  1  oz.,  or  28  grammes,  containing  0    28 


Total         ...  ...      95    99  245 

or,  since  18  ounces  is  altogether  too  much  bread  for 
a  man  to  eat  in  a  day,  say,  nine  ounces  of  bread  and 
one  pound  of  rice  pudding,  containing  one  egg,  and 
say,  six  or  seven  ounces  of  lean  meat.  This  is  the 
allowance  for  a  large  man.  Most  men  weigh  a 
good  deal  less  than  this  ;  but  even  so  it  is  about 
30  ounces  of  mixed  diet  daily.  At  the  same  rate, 
a  man  weighing  120  pounds  (we  are  not  told  if 
Ranke's  weight  included  his  clothes)  or  three- 
quarters  of  this  weight  would  require  three-quarters 
of  this  allowance  of  food  daily.  That  is,  6|  ounces 
of  lean  meat,  about  13  ounces  of  bread,  Ij  ounce  of 
butter,  and  J  ounce  of  fat — i.e.,  about  22  ounces  of 
food  as  it  comes  to  the  table. 

But  we  are  not  told  for  how  long  E,anke  per- 
sisted in  taking  this  diet,  and  whether,  for  instance, 
he  had  any  "  colds,"  rheumatism,  bronchitis, 
headaches,  or  other  ailments.  Most  townsmen  of 
my  acquaintance  would  suffer  from  dyspepsia, 
constipation,  herpes  labiorum,  bronchitis,  rheu- 
matism,   pruritus    ani  —  one    or    more    of    these 


277 

affections — if  they  took  anything  like  so  large  a 
quantity  of  bread  as  18  ounces  daily  for  any  length 
of  time.  Nine  ounces  of  meat  is  also  a  large 
quantity  to  take  daily. 

The  demands  of  Moleschott  are  higher  than 
those  of  Ranke,  viz.  :  Proteids  120  grammes,  fat 
90  grammes,  and  carbo-hydrates  333  grammes.  But 
most  men  habitually  take  much  more  food  than 
these  allowances. 

It  has  become  customary  in  recent  years  to 
estimate  diets  in  what  is  called  calorie  value,  and 
perhaps  we  ought  to  do  so  here.  Food  eaten 
represents  so  much  potential  energy,  capable  in  the 
body,  as  fuel  in  a  furnace,  of  being  converted  into 
so  much  kinetic  energy,  which  latter  takes  the 
form  of  maintaining  bodily  heat,  or  of  doing  work. 
"  To  determine,"  says  Professor  Davis,  "  the 
amount  of  potential  energy  in  food  eaten,  it  is 
necessary  to  know  how  much  food  is  consumed  and 
the  potential  energy  of  food  stuffs.  The  calorie 
is  the  unit  that  has  been  fixed  upon  to  express  the 
energy  stored  in  food.  A  calorie  is  the  amount  of 
heat  required  to  raise  one  gram  of  water  1°  C.  The 
most  convenient  way  in  which  to  estimate  the  value 
of  food  stuffs  is  to  determine  how  many  calories  a 
given  weight  wiU  furnish.  It  has  been  established 
that  one  gram  of  dry  proteid  will  furnish  4000 
calories,  the  same  quantity  of  carbohydrate  4180 
calories,  and  the  same  quantity  of  fat  9400  calories. 
With  these  facts  known,  it  is  easy  to  determine 
the  calories  that  any  given  food  stuff  will  furnish, 


278 

provided  the  percentages  of  proteid,  fat  and  carbo- 
hydrate    that     it     contains     are     known.       These 
percentages  must  be  multiplied  by  the  figures  just 
given,     and    their    results     added,     in     order     to 
ascertain    the    number  of  calories  in  100  grams  of 
food."     This   is   the   scientific  doctrine  of  the  day, 
what  may  be  called  the  formal  statement  of  the 
scientific    position    on    the   subject.     Obviously    it 
requires     translation    into    pounds    or     ounces    of 
ordinary  mixed  food  as  it  comes  to  the  table,  and 
proportionment    to    the   business   of    life,    whether 
that  of  brain-worker  or   hand-worker,    and  if   so, 
whether   a    light    hand-worker   or   a    heavy  hand- 
worker, before  it  is  of  much  use  in  practical  life  to 
practical  people.     Ranke's  diet  aforesaid  obtainable 
from  the  meat,  bread,  butter,  &c.,  mentioned,  w^orks 
out  to  about  2355  grand  calories.     (A  grand  calorie 
is    1000    small   calories,    or    the    quantity    of    heat 
required  to  raise  1000  grammes  of  water  through 
one   degree  Centigrade.     I  always  state  results   in 
grand  calories,  and  to  avoid  the  use  of  long  figures  ; 
for    2335  grand  calories  would  be  2,335,000   small 
calories,   a   longer  and  probably  a   more  confusing 
number).      Moleschott's    diet    works   out    to    2718 
grand  calories.     Play  fair's  full  health  diet  of   118 
grams  proteid,  50  grams  fat,  and  528  grams  carbo- 
hydrate, comes  to  3140  grand  calories.     The   same 
authority     makes    the    diet    of    active     labourers 
demand  155  grams  proteid,  73  grams  fat,  and  568 
grams  carbo-hydrate,  which  comes  to  3630  grand 
calories.     I  append  below  a  short  table  embodying 


279 

the  views  of  other  authorities,  so  that  the  reader 
may  see  at  a  glance  how  widely  they  differ  on  this 
subject. 


Authority.                                               Proteids. 

Fats. 

Carbo-hydrates. 

Calories 

Voit- 

-Moderate  Work         ...     118 

55 

500 

3055 

Do. 

Hard  Work                ...     145 

100 

450 

3370 

Atwater  —Little  Exercise     ...       91 

91 

300 

2450 

Do. 

Light  Muscular  Work  100 

100 

350 

2800 

Do. 

Moderate  „            ,,       127 

127 

500 

3520 

Do. 

Active       ,,           ,,       150 

150 

500 

4060 

Do. 

Hard         „           „       177 

250 

650 

5700 

It  appears  to  me — I  respectfully  suggest  it  to 
these  eminent  authorities — ^that  all  these  dietary 
requirements  are  too  high  as  measured  by  the  test 
as  to  whether  the  persons  who  take  them  remain 
well  for  a  long  time,  say  a  year  or  two,  or  longer. 
It  seems  to  me  that  all  my  experience  says,  and 
that  firmly  and  decidedly,  that  such  diets  make 
people  ill,  at  least  those  people  who  live  in  towns 
and  do  town  work.  They  cannot  bear  them  without 
suffering  in  a  variety  of  ways.  A  patient  of  mine, 
for  example,  suffering  from  a  variety  of  ailments, 
was  advised  to  greatly  restrict  his  diet  in  order  to 
get  rid  of  them.  He  belonged  to  that  large  and 
increasing  class  of  the  community  living  in  towns, 
who  now  form  the  bulk  of  the  population  of  these 
islands,  and  who  may  fairly  be  described  as  persons 
with  little  muscular  exercise  or  as  doing  light 
muscular  work.  He  suffered  from  dyspepsia  and 
heartburn,  frequent  colds,  resulting  in  bronchitis 
and  recurrent  attacks  of  sneezing  and  bronchial 
asthma,  recurring   attacks   of   herpes   of  the   lips. 


280 

that  is,  eruptions  of  watery  blisters  on  the  Hps, 
which  in  course  of  time  became  dry  and  scabbed 
over  and  then  cleared  oft';  recurring  little  sores 
similarly  produced  on  the  tongue,  constipation,  and 
general  rheumatism,  making  his  back  and  limbs  and 
muscles  ache  and  become  tired  long  before  the 
reasonable  and  moderate  exertion  he  made  could 
possibly  account  for  it ;  in  fact,  he  often  woke  tired 
in  the  morning  after  six  or  seven  hours  sleep  ;  and 
sometimes  he  could  not  sleep  till  say  three  o'clock 
in  the  morning,  while  sometimes  he  would  sleep  for 
two  hours,  and  then  waking  might  have  an  attack 
of  asthma  which  would  keep  him  awake  not  less 
than  two  hours,  while  occasionally  he  could  not  sleep 
at  all.  For  this  large  variety  of  ailments,  plainly 
portending  the  more  or  less  speedy  onset  of  more 
serious  and  possibly  incurable  disease,  he  was  advised 
greatly  to  restrict  his  diet.  He  weighed  about  140 
pounds,  so  that  according  to  Ranke  he  required  85 
grams  proteids,  85  grams  fats,  and  205  grams 
carbo-hydrates.  What  he  did  take  in  two  meals, 
seven  or  eight  hours  apart  from  one  another,  was 
the  following  : — Lean  meat,  3  ozs.,  or  fish,  3  ozs.  ; 
bread,  about  4  ozs.  ;  rice,  about  4  ozs.,  uncooked 
(4  ozs.  of  uncooked  rice  equals  1  lb.  of  rice 
pudding)  ;  butter,  about  2  ozs.  ;  cheese,  1  oz.  to 
2  ozs.  and  over ;  and  one  egg  on  some  days,  and 
some  days  no  egg.  This  works  out  to  about  60 
grams  proteids,  85  grams  fats,  and  say  150  grams 
carbo-hydrates.  After  losing  weight  a  little  on  this 
diet,  he  afterwards  regained  it  up  to  about  133  lbs., 


281 

and  incidentally  he  got  rid  of  every  ailment  he  had, 
so  that  from  being  a  delicate,  pale,  pasty-looking 
man,  disinclined  for  exertion,  he  became",  well 
coloured,  healthy-looking,  and  fresh  and  able  for 
exertion  at  all  times  of  the  day.  I  do  not  think 
that  Ranke's  requirements  are  far  out  for  the 
average  townsman  doing  office  work  or  the  work  of 
an  active  business  man,  or  the  work  of  a  townsman 
generally,  be  he  professional  or  layman,  but  I  think 
even  his  diet  errs  on  the  side  of  too  much  rather 
than  on  that  of  too  little.  It  will  be  observed  that 
my  patient's  diet  works  out  to  about  1666  grand 
calories,  i.e.,  60  grams  proteids  x  4,  85  grams  of 
fats  X  9'4,  and  150  grams  carbo-hydrates  x  4*18, 
and  this  is  just  about  two-thirds  of  what  Ranke's 
diet  amounts  to  (2325).  But  Ranke's  diet  is  lower 
than  Moleschott's,  or  than  Voit's,  for  moderate 
work,  or  even  than  Atwater's  for  little  exercise, 
while  it  is  very  much  less  indeed  than  Atwater's 
diet  for  active  work  (4069  calories),  or  for  hard 
work  (5700  calories).  I  confess  that  it  is  a  severe 
violation  of  my  conclusion  from  all  the  observations, 
that  have  forced  themselves  on  me  in  a  prolonged 
experience  to  be  asked  to  believe  that  almost  any 
man  can  stand  for  long  a  diet  amounting  to  5700 
grand  calories  daily.  However  strong  a  man  might 
be  who  took  this  amount  of  food,  and  however  hard 
he  worked,  I  do  not  think  he  could  possibly  oxidise 
it  off,  and  I  feel  sure  that  between  overloading  his 
digestion  and  overworking  his  muscles  he  would 
speedily  fall   into    an    incurable    illness   on  such  a 


282 

regime.  Other  authorities  mention  enormous  quan- 
tities of  food  as  justifiable  to  be  taken  in  health,  as, 
e.g.,  4|  pounds  of  mixed  diet,  while  even  Dr.  King 
Chambers,  who  introduced  the  phrase  "  Starvation 
from  over  -  repletion,"*  recommends  the  nursing 
mother  to  take  three  pounds  of  mixed  diet  daily. 
In  my  opinion,  the  ordinary  townsman  requires  \\ 
pounds  of  mixed  diet  daily,  from  that  as  a  liberal 
estimate  down  to  three-quarters  of  a  pound  as  a  not 
unusual  one,  if  he  wishes  to  be  well  and  to  keep  so, 
while  a  woman  requires  even  less  than  this.  This 
would  be  my  translation  into  the  language  of  every 
day  life  of  Professor  Davis's  statement  that  "  we 
habitually  eat  more  than  is  needed  to  supply 
waste."  We  cannot  go  on  putting  into  the  animal 
economy  more  supplies  than  are  needed  for  its 
smooth  and  easy  and  efl&cient  working,  without 
rendering  the  working  of  it  hard,  difficult  and 
inefficient  by  clogging  and  choking  it  up. 

Contrast  with  these  diets  Dr.  Haig's  Diet 
Table  II.,  in  his  little  book.  Diet  and  Food  in 
Relation  to  Strength  and  Power  of  Endurance. 
Table  II.  is  as  follows  : — 5  ozs.  Hovis  bread,  2  ozs. 
oatmeal,  1  oz.  gluten,  3  ozs.  cheese  ;  or  a  total  of 
11  ounces  of  solid  food  with  one  pint  of  milk  daily. 
If  the  tw^o  ounces  of  oatmeal  be  made  into  half  a 
pound  of  porridge,  the  total  weight  of  this  diet  is 

*NoTE. — My  friend  Dr  Dewey  has  used  the  phrase  "starvation  from  over- 
feeding," not  knowing  of  Dr.  King  Chambers'  prior  expression.  Here 
again  we  are  forced  to  exclaim :  How  one  generation  discovers,  how 
its  successors  forget  or  overlook,  and  how  we  have  to  discover  again, 
to  the  great  loss  of  our  time  and  damage  to  progress  ! 


283 

17  ounces  and  a  pint  of  milk  ;  and  Dr.  Haig  says  it 
is  enough  for  the  average  man.  I  think  he  is  right ; 
but  if  this  is  so,  it  at  once  follows  that  all  of  us 
take  too  much  food,  for  certainly  none  of  the 
people  of  my  acquaintance  take  so  little  food  as 
this  (except,  indeed,  some  of  those  who  have  been 
very  ill,  and  have  reduced  their  diet  under  medical 
advice). 

Cornaro,  it  is  well  known,  lived  from  the  age 
of  38  years,  when  he  suffered  greatly  from 
dyspepsia  and  many  ailments,  till  the  age  of  97,  or 
for  a  period  of  59  years,  on  a  diet  of  12  ounces  of 
mixed  food  daily  and  14  ounces  of  red  wine.  His 
age  at  death  is  variously  given,  but  was  not  less 
than  97,  and  he  himself  believed  it  might  have  been 
much  more  if  he  had  not  abused  his  constitution  in 
his  youth. 

In  connection  with  Cornaro  and  the  length  of 
time  he  lived,  and  that  in  good  health,  on  a  very 
restricted  diet,  I  cannot  forbear  making  an  obser- 
vation. It  was  Addison  who  introduced  the  story 
of  Cornaro  to  English  readers.  It  was  he  who 
translated  from  the  Italian  the  treatises  which 
Cornaro  wrote  on  health  and  longevity ;  and  it  was 
Addison  who  knew,  if  anyone  did,  how  longevity 
had  been  attained.  How  did  Addison  behave 
himself?  After  breakfasting  about  eight  or  nine  in 
the  morning,  he  would  drop  into  a  coffee  tavern 
perhaps  in  the  forenoon,  sipping  coffee  and  stronger 
drinks.  He  would  lunch  about  one  o'clock,  and 
spend  the  afternoon  as  he  spent  the  morning ;  and 


284 

dine  (or  sup)  from  seven  to  eight  in  the  evening, 
keeping  up  hilarious  nights  till  the  small  hours  of 
the  morning.  The  consequences  of  this  were,  as 
Addison  must  have  well  known  that  they  would  be, 
death  at  49  years  of  age,  from  severe  asthmatical 
distress  of  breathing,  and  general  dropsy. 

In  infirmaries,  where,  if  anywhere,  persons 
ought  to  be  properly  fed,  it  is  customary  to  allow 
about  16  ounces  of  bread  daily,  besides  other  food, 
to  each  patient.  This  is  very  much  too  large  an 
amount  for  health  on  the  average,  Anything 
beyond  from  six  to  eight  ounces  of  bread  daily  is 
sufficient  to  cause  in  men  and  women  doing  ordinary 
town  work  a  variety  of  ailments,  most  of  which 
are  usually  attributed  to  "  taking  cold."  Common 
examples  of  these  are  watery  blisters  on  the  lips 
and  tongue,  pimples  and  spots  on  the  face,  so 
frequently  seen  in  young  people  who  are  fond  of 
bread  and  cakes,  and  take  them  too  often  and  too 
much,  inflammation  of  the  windpipe  and  bronchial 
tubes,  inflammation  of  the  mucous  membranes  of 
the  eyes  and  nose,  sore  throats,  enlargements  of  the 
glands  of  the  neck,  constipation  (or  diarrhoea 
sometimes),  and  rheumatism,  &c.  Although  the 
remote  effects  of  the  digestion  and  assimilation  of 
food  is  to  increase  the  strength  and  to  build  up  the 
tissues  of  the  body,  it  does  not  seem  to  be  generally 
realised  as  it  ought  to  be,  that  the  immediate  effect 
is  to  place  a  labour  and  often  a  severe  labour  on 
the  body,  and  that  this  for  a  time  shews  itself  in 
depression    of    the   body   by  using  up  part  of  its 


285 


energy  in  the  digestive  processes.  Too  frequent 
repetition  of  this  labour  in  the  body  by  the  taking 
of  too  many  meals,  especially  when  the  amounts  of 
food  taken  are  greater  than  the  bodily  requirements, 
often  seems  to  exert  an  influence  of  cumulative 
depression,  and  accounts  for  the  subnormal  state  of 
the  temperature,  which  so  often  precedes  the  onset 
of  chronic  and  of  incurable  disease,  as  was  shewn 
in  the  chapters  dealing  with  the  paradoxes  of 
medicine.  And  it  was  then  also  shewn  how  a  hot 
drink  (of  cojBTee,  e.g.),  might  raise  the  bodily 
temperature  for  an  hour  or  two,  although  not  itself 
supplying  material  for  oxidation  and  combustion. 
The  cup  of  afternoon  tea  often  acts  in  the  same 
way,  and  its  mode  of  action  explains  also  the  advice 
given  not  to  eat  anything  with  it,  since  food 
interpolated  then  will  find  lunch  undigested,  while 
in  turn  it  will  not  itself  be  digested  when  the 
evening  meal  is  taken.  It  cannot  be  wise  to  have 
digestion  going  on  at  two  different  stages  in  the 
same  stomach  at  the  same  time.  And  if  the 
temperature  of  the  body  is  subnormal  from  an 
excess  of  material  present  there  is  all  the  more 
reason  to  abstain  from  food,  which,  if  taken,  can 
only  aggravate  the  depression  already  existing, 
after  the  immediate  effects  of  the  stimulation  shall 
have  passed.  And  study  of  what  goes  on  in  such 
circumstances  in  the  body  explains  how  fasting  may 
sometimes  be  of  such  great  benefit,  since  fasting,  by 
inducing  the  organism  to  use  up  some  of  the 
material     accumulated     in     it    in     excess,     takes 


286 

the  load  off  to  some  extent  and  enables  the 
organism  to  rise  to  natural,  when  the  burden 
clogging  it  in  every  capillary  vessel  and  in 
every  lymph  duct  has  been  lightened.  A  case 
which  I  treated  some  years  ago  illustrates  so  well 
the  points  just  referred  to,  and  also  raises  for  our 
consideration  another  method  of  estimating  the 
quantity  of  food  required  by  the  body,  that, 
although  I  have  already  mentioned  on  p.  261 
another  feature  in  the  case,  I  may  be  pardoned 
for  recapitulating  the  main  facts  of  it  here.  A 
man  47  years  of  age,  a  labourer  in  a  foundry, 
when  he  was  able  to  work,  but  who  had  not 
worked  for  over  seven  years  at  the  time  of  which 
I  speak,  submitted  on  my  recommendation  to 
a  long  fast  in  order  that  he  might,  if  possible,  be 
cured  of  recurrent  vomiting,  which  had  troubled 
him  for  all  that  time.  He  had  had  much  and 
careful  treatment  from  distinguished  medical  men, 
but  with  little  or  no  benefit.  Except  that  he  had 
the  whey  from  two  pints  of  milk  daily,  he  had  no 
food  of  any  sort  except  water  from  31st  August  till 
5th  October,  1898.  The  solids  in  30  ounces  of 
whey  do  not  at  the  outside  amount  to  more  than 
two  ounces  (I  do  not  myself  think  they  amount  to 
so  much),  but  we  shall  assume  that  the  man  had 
two  ounces  of  solid  food  daily  during  that  time. 
Now  what  was  the  weight  loss  of  his  body?  It 
amounted  to  13:^  pounds  in  35  days,  not  lost 
continuously  and  equably  during  that  time,  but 
intermittently.     From  the  ninth  to  the  thirteenth 


287 

day  of  the  fast,  for  instance,  he  lost  no  weight  at 
all,  while  from  the  twenty-ninth  to  the  thirty-fifth 
day  of  the  fast  he  lost  three  pounds  in  weight. 
But  on  the  average  the  loss  during  the  35  days  was 
about  six  ounces.  This,  added  to  two  ounces  of 
food  taken  (if  it  was  so  much),  implies  that  the 
man's  economy  used  about  half  a  pound  of  the 
material  of  his  body  daily  on  the  average  to  keep 
himself  alive ;  and,  therefore,  I  take  it  we  are 
entitled  to  conclude  that  about  eight  ounces  daily 
of  mixed  diet  is  suf&cient  to  enable  a  man  of  130 
pounds  weight  to  subsist  and  keep  himself  alive  if 
he  does  not  do  any  more  work  than  my  patient  did, 
that  is,  walk  about,  and  help  his  wife  in  little 
domestic  duties  like  making  beds,  laying  the  table, 
and  washing  up  dishes.  This  loss  of  eight  ounces 
daily  corresponds  well  with  some  other  observations 
of  mine,  and  cannot  as  a  subsistence  diet,  be  con- 
sidered unusual.  For  instance,  a  lady  patient  of 
mine,  suffering  from  rheumatism,  constipation,  and 
a  variety  of  ailments,  maintained  her  weight  for  a 
considerable  period  of  time  on  eight  ounces  of  food 
a  day,  her  health  improving  very  much  in  almost 
every  particular  during  the  process,  including 
the  complete  cure  of  constipation.  When  she 
added  two  raw  apples  daily  to  this  diet,  as  a 
second  meal,  she  slightly  gained  weight.  From 
facts  like  these  I  conclude  that  eight  ounces  of 
mixed  food  daily  (not,  of  course,  eight  ounces  of 
white  bread,  but  of  mixed  diet)  is  a  subsistence  diet 
for  people  moving  about  and  doing  no  work  beyond 


288 


the  lightest  sorts,  or  such  work,  for  instance,  as  a 
sempstress   does.       They    can    just   maintain   their 
weight    on    it.       It   does   not    seem,    therefore,    an 
unreasonable  inference  from  these  facts  to  conclude 
that  persons  could  do  the  active  but  not  laborious 
work  of  an  overlooker  in  a  mill,  of  a  weaver,  of  a 
joiner,  of  a  doctor,  of  a  lawyer,  or  of  a  shopman  or 
clerk,    or  of   a  lady  looking  after  the  conduct  of 
a   household,    or,    in   fact,    of    the    average    town- 
dweller,  on  an  amount  of  food  represented  by  the 
addition  of  say  six  or  eight  ounces  more.     This  14 
or  16  ounces  of  food  brings  us  very  near  to  Cornaro's 
12  ounces,  with  14  ounces  of  red  wine,  rendering 
his  estimate  and  practice  a  far  more  reasonable  and 
credible  amount    than   we  might  have  thought   if 
we  had  had  regard  only  to  the  almost  invariable 
habit  of  mankind  to  take  much  more.     It  contrasts 
strongly  with  the  light  or  moderate  diet  of  E-anke, 
which   would   amount   with  the  water  of   cooking 
added  to  not  less  than   30  ounces.     But  when  we 
come  to  think  of  4|  pounds  or  four  pounds  of  food, 
it  does  not  seem  possible  that   in  any  conceivable 
circumstances  so  much  can  be  required  ;  and  if  so 
much  is  taken,  it  is  difficult  to  escape  the  conclusion 
that  the  body  must  suffer   for  it  in   a   variety  of 
ways.     Next,   let   us   consider   the   late   Dr.    King 
Chambers'  advice  that  the  nursing   mother  should 
have  three  pounds  of  ordinary  food  daily,  and  whose 
only    fear    was,  as    he    said,    lest    she    should    not 
have  enough.     A  baby  will  require  from  12  ounces 
of  breast  milk  up  to  say  two  pints  daily,  according 


289 

to  age.  This  would  involve  the  addition  to  the 
mother's  ordinary  diet  of  say  four  ounces  of 
extra  food.  Or  suppose  that  she  took  even 
two  pints  of  milk  daily  over  and  above  her 
normal  food,  that  would  only  be  600  calories. 
Even  if  her  ordinary  diet  consisted  of  Ranke's 
demand  for  a  large  man,  she  could  not  possibly  be 
made  out  to  require  more  than  two  pounds  of  food, 
so  that  Dr.  King  Chambers'  demands  for  three 
pounds  is  one  which,  if  satisfied,  must  clog  the 
woman's  economy  and  make  her  iU,  even  if  she 
added  to  her  nursing  labours  that  of  wheeling  the 
perambulator,  as  many  mothers  do.  But  if  her 
ordinary  diet  consisted  of  say  16  ounces  of  food, 
then  her  nursing  diet  might  amount  to  20  ounces, 
or  1|-  pound,  or  perhaps,  if  we  are  very  liberal,  to 
1|-  pound,  just  half  of  the  amount  advised  by  Dr. 
King  Chambers.  I  am  quite  sure  that  taking  such 
diets  as  his  makes  women  ill.  These  estimates 
differ  so  widely  that  one  is  surprised  at  the 
difference.  Why,  in  the  E-oyal  Navy,  where  men 
are  freely  exposed  to  the  oxidising  influences  of  the 
ocean  air,  and  are  besides  engaged  during  much  of 
the  time  in  doing  laborious  work,  the  full  allowance 
of  food  is  about  three  pounds  daily,  viz.,  one  pound 
of  fresh  meat,  half  a  pound  of  vegetables,  one  and 
a  quarter  pound  of  biscuits,  two  ounces  of  chocolate, 
a  quarter  of  an  ounce  of  tea,  and  one-eighth  of  a 
pint  of  spirit.  It  is  said,  though  I  do  not  know 
with  how  much  truth,  that  the  ordinary  seaman 
does  not  use  so  much  food  as  this,  and  that,  when 
s 


290 

left  to  follow  his  inclinations,  he  takes  not  three 
pounds  of  food  but  30  ounces  on  the  daily  average, 
or  about  two  pounds.  I  must  say  that  to  eat  one 
and  a  quarter  pound  of  sea-biscuit  daily  is  a  task 
that  the  ordinary  man  might  well  shrink  from ;  and 
one  shudders  to  think  of  the  indigestion,  constipa- 
tion, acne,  and  rheumatism  it  must  cause,  when  taken 
to  such  an  extent,  and  in  addition  to  other  food. 

Another  point  of  great  importance  and,  on  the 
surface,  of  some  considerable  difficulty,  becomes 
cleared  up  by  this  line  of  observation  and 
reflection.  The  first  effect  of  a  fast  is  said  to  be  to 
increase  the  number  of  the  corpuscles  of  the  blood. 
Now  as  the  function  of  food  is  to  make  blood,  and 
as  the  food  therefore  makes  the  corpuscles,  it  seems 
at  first  sight  impossible  to  conceive  how  stopping  or 
greatly  diminishing  food  supply  can  increase  the 
nmnber  of  the  blood  corpuscles.  It  ought  to 
diminish  them,  and  in  fact,  in  course  of  time,  if  the 
fast  is  persisted  in,  it  does  diminish  them.  But 
the  explanation  is  really  very  simple.  Most  of  us 
are  over-fed,  and  the  consequence  of  this  is  that  the 
tissues  are  blocked  or  choked,  because  too  much 
material  finds  its  way  into  the  blood.  This  directly 
prevents  the  blood-making  processes  from  going  on. 
The  process  is  checked  because  the  capillary  vessels, 
the  lymph  spaces,  the  lymph  ducts,  and  the  muscular 
coverings,  and  the  tissue  coverings,  and  the  connec- 
tive tissues  generally,  are  blocked.  Consequently 
there  is  an  accumulation  of  waste  unused  material 
in  the  body.     This  accumulation  often  lowers  the 


291 

temperature  and  prevents  and  checks  the  accomplish- 
ment of  all  the  processes  of  the  body,  and,  among  the 
rest,  of  the  important  process  of  the  manufacture  of 
the  blood  corpuscles.  But  when  a  fast  is  instituted, 
the  body  must  live  on  something,  and  it  calls  up 
into  the  capillary  and  lymph  circulation  minute 
particles  of  tissue  and  of  accumulations  which  had 
not  yet  become  tissue,  and  oxidises  these  in  order 
to  maintain  the  bodily  heat  and  energy.  The 
consequence  of  this  is,  by  gradually  removing  the 
block  from  the  tissues,  to  allow  the  blood-making 
process  (and  other  processes  also,  no  doubt),  to 
proceed  for  a  time  more  healthily  and  more 
vigorously,  until  in  course  of  time  —  it  often 
takes  a  few  weeks  for  this  to  happen  —  all  the 
unused  stuff  has  been  made  use  of,  after  which  the 
corpuscles  begin  to  diminish.  If  the  fast  is  pushed 
to  actual  death,  of  course  all  functions  and  all 
processes  come  to  an  end,  and,  long  before  the  man 
dies,  there  is  no  blood  formation  going  on  in  his 
body.  But  the  explanation  of  the  difficulty  that 
fasting  should  even  at  first  increase  or  seem  to 
increase  the  number  of  the  blood  corpuscles,  when 
prolonged  fasting  certainly  diminishes  them,  becomes 
really  quite  easy.  It  depends  on  the  economical 
tendency  of  nature  to  accumulate  reserve  stocks  in 
the  body,  so  that  under  any  stress  or  strain  she 
shall  be  able  to  go  on  for  some  time  even  without 
the  ordinary  and  regular  supplies  of  food.  Inci- 
dentally we  also  see  how  over-feeding  lowers  the 
bodily  temperature,  and  how  fasting  at  first  raises 

S  2 


292 

it  to  normal,  and  may  even  by  reaction  raise  it 
above  normal,  or  may  cause  fever,  after  which,  of 
course,  it,  like  the  blood-making  processes,  falls, 
and  is  checked  by  fasting.  And  we  also  see  how  it 
is  important  that  some  reserves  should  always  be 
present  in  the  body  so  that  they  can  be  drawn  on  in 
case  of  need.  But  the  great  test  as  to  whether  the 
reserves  are  in  excess  is  the  state  of  the  tempera- 
ture and  of  the  other  functions  of  the  body,  which, 
as  we  have  seen,  are  reduced  by  too  much.  They 
are  so  reduced,  at  least,  when  the  body  is  tolerant  of 
the  irritation  of  too  much,  although  not  infrequently 
we  find  the  opposite  condition  set  up  by  the  same 
cause,  viz.,  irritation  with  intolerance  or  reaction, 
when  we  get  feverish  temperature  and  almost  all  of 
the  functions  heightened  or  elevated  for  a  time. 

This  state  of  body  explains  some  otherwise 
inexplicable  conditions.  I  have,  for  example, 
referred  many  times  in  the  course  of  these 
observations  to  fasts  which  have  lasted,  not  for 
hours  or  days,  but  for  many  weeks  ;  after  which,  in 
numerous  cases,  patients  have  recovered  from  severe 
and  long-continued  illnesses.  With  these  facts 
before  us,  what  are  we  to  say  of  a  statement  that, 
for  example,  English  soldiers  actually  died  (it  was 
freely  said  of  starvation)  after  being  exposed  to  the 
fatigue  of  military  manoeuvres  for  eight  hours  in 
the  heat  of  an  English  summer  at  Aldershot,  and 
after  being  deprived  of  food  for  eight  hours  ?  That 
they  unfortunately  died  is  not  to  be  questioned; 
but  they  certainly  did  not  and  could  not  have  died 


293 

of  starvation.  But  if  they  had  been  over  fed 
before,  or  if  they  had  taken  much  alcohol,  then  the 
waste  unassimilated  stuff  within  them  might  easily 
go  into  excessive  combustion  or  oxidisation ;  an 
acute  and  feverish  poisonous  condition  might  be  set 
up,  which  might  easily  cause  severe  illness  and  even 
death.  And  the  remedy,  the  true  remedy,  would 
be  rather  the  inculcation  of  such  food  habits  (and 
drink  habits)  as  would  render  the  body  healthy 
enough  and  strong  enough  to  bear  easily  such  an 
amount  of  fatigue  as  they  might  expect  to  have  to 
undergo  at  any  time  in  actual  war,  than  to  condemn 
the  War  Office  and  the  military  authorities  for  their 
barbarity  in  not  supplying  the  men  with  bovril,  &c., 
while  on  the  march.  Nevertheless,  the  outcry  in 
the  public  prints  a  couple  of  years  ago  took  only 
the  latter  form,  while  not  one  word  was  said  in 
condemnation  of  those  previous  habits,  which,  there 
could  be  no  doubt,  led  to  the  catastrophe.  And  the 
chief  trouble  is  that  the  sufferings  of  the  soldiers, 
and  the  loss  of  valuable  lives  to  the  country,  are 
certain  to  have  been  in  vain,  until  we  learn  what 
the  causes  of  both  were,  and  until  we  take  proper 
steps  to  obviate  them.  Because,  after  all,  it  is  very 
doubtful  whether  the  order  in  future  to  administer 
refreshment  to  soldiers  on  the  march  will  have  the 
effect  expected.  Besides  all  which,  of  what  use  to 
their  country,  it  may  be  pertinently  inquired,  are 
soldiers  who  are  so  weak  that  they  cannot  march 
eight  hours  in  warm  but  not  tropical  weather 
without    halting  to  take  refreshment  ?     Would  an 


294 

enemy  be  so  considerate  as  to  intermit  their  attack 
while  our  men  were  so  employed  ? 

It  is,  then,  the  man  with  reserves  in  him 
from  over-feeding,  whose  corpuscles  become  more 
numerous  from  fasting  (for  a  time),  and  it  is  only 
when  the  process  of  accumulation  of  reserves  has 
been  carried  to  excess,  that  the  condition  has  become 
unhealthy.  The  conclusion  of  the  whole  matter  is — 
what  everyone  knows  and  admits  theoretically,  but 
hardly  anyone  carries  out  into  practice — that  modera- 
tion is  the  only  fixed  and  the  only  unfailing  rule. 
Ne  quid  nimis.  M-qhkv  ayav.  Nothing  too  much. 
There  is  nothing  new  in  this.  It  has  been  all  said 
before.  And  yet  the  translation  of  it  is  somewhat 
new.  For  what  is  moderation?  That  is  the  question. 
Well,  moderation  differs  in  different  circumstances ; 
but  for  the  average  man  and  woman  living  in  a 
town,  that  is  for  the  average  man  and  woman  in 
England  to-day  (and  in  most  other  countries,  too), 
moderation  is  much  nearer  to  the  amount  of  food 
mentioned  by  Cornaro,  the  12  ounces  of  mixed  food 
as  it  comes  to  the  table,  with  the  14  ounces  of  red 
wine,  than  it  is  to  the  scale,  or  rather  the  widely 
varying  scales,  of  some  of  the  modern  physiologists. 
I  am  certain  at  least  that  this  is  so,  if  the  aim  of 
medicine  is  to  be,  as  I  think  it  ought  to  be,  to 
increase,  and  lengthen,  and  make  more  vigorous  for 
active  work,  and  also,  while  it  lasts,  less  susceptible 
to  illness,  the  life  of  man  on  this  planet.  Only  he 
knows  or  can  appreciate  the  discouragement  caused 
by  looking  on  and  seeing  active  and  useful  human 


295 

organisms  rendered,  sometimes  quickly  and  some- 
times slowly,  inactive  and  useless  by  being  silted 
up  and  choked  with  too  much  food — only  he  can 
adequately  appreciate  the  discouragement  and 
sorrow  caused  by  the  loss,  one  after  the  other,  of 
friends  or  acquaintances,  who  has  been  forced  to 
reflect  that  such  loss  might  easily  in  most  cases 
have  been  postponed  by  from  five  to  twenty  years, 
if  more  rational  ideas  had  prevailed  on  this  simple 
subject,  and  if,  prevailing,  they  had  been  translated 
into  the  conduct  and  habits  of  everyday  life.  The 
causes  of  death  seem,  to  be  attributed  to  every 
reason  but  the  right  one.  It  is  bronchitis,  it  is 
pneumonia,  it  is  Bright's  disease,  it  is  cancer, 
it  is  tuberculosis,  it  is  apoplexy ;  but  the  causes  of 
these  causes — who  says  anything  about  them  ? 
About  the  drinking  (yes,  we  are  alive  to  that),  but 
particularly  about  improper  feeding  as  a  cause  of 
the  causes  of  too  early  death — how  is  it  that  we 
are  all  so  blind  to  this  ?  How  many  young  lives 
are  sacrificed  on  the  altar  of  over-feeding  ?  Well,  I 
am  glad  to  see  that  our  medical  of&cers  of  health 
are  beginning  to  warn  us  of  this.  One  is  apt  to  be 
accused  of  extravagant  statements  if  one  attempts 
to  answer  this  question.  In  time,  however,  the 
labours  of  our  medical  officers  of  health  will  teU 
in  this  direction.  But  how  many  wives  have  been 
made  widows ;  how  many  husbands  have  been  left 
wifeless  ;  how  many  both  wives  and  husbands  have 
gone  to  asylums,  and  how  many  children  have 
been    left    orphans    from    this    cause?      It    were 


296 

much  to  be  wished  that  we  could  induce 
our  people  to  ask  and  answer  these  questions. 
If  only  a  small  part  of  the  ability  so  abundant 
in  life  were  directed  to  the  consideration  of 
the  simple  questions,  how  much  food  is  necessary 
and  desirable  for  the  adequate  but  not  excessive 
nutrition  of  the  body  of  the  average  man,  and 
woman,  and  child,  and  how  often  should  that  food 
be  taken  ;  what  a  harvest  of  information  and  what 
a  harvest  of  happiness  would  be  reaped.  If  our 
Medical  Council,  instead  of  crowding  the  medical 
curriculum  with  more  or  less  useless  knowledge  (all 
knowledge  is  useful,  no  doubt,  and  I  do  not  despise 
any  of  it,  but  some  forms  of  knowledge  are  much 
more  useful  than  others)  about  bacteria,  and  germs, 
and  micro-organisms,  would  insist  on  instituting  a 
chair  of  dietetics  in  every  medical  school ;  or, 
perhaps,  better  still,  if  our  Municipal  and  County 
Councils  would  found  lectureships  on  this  simple 
subject,  so  germane  to  practical  life  ;  and  if  the 
occupants  of  such  chairs  iind  if  such  lecturers  would 
tell  the  people  what,  and  how,  and  how  often  they 
should  eat  and  drink,  and  what  are  the  effects  of 
improper  eating  and  drinking,  the  effects  would,  I 
am  sure,  be  such  as  to  astonish  us  all  by  their 
magnitude,  and  importance,  and  far-reachingness. 

There  are  still  one  or  two  questions  remaining 
for  consideration  before  we  can  complete  the  dis- 
cussion of  the  question  how  often  ought  we,  e.g., 
to  eat  in  order  to  be  well,  and  fit  for  work.  There 
have  been  very  different  practices  followed  in  this 


297 

respect  by  different  nations ;  but  a  considerable 
amount  of  additional  knowledge  has  been  gained 
regarding  it  of  late  years.  As  to  the  time  required 
for  the  digestion  of  food,  and  as  a  consequence  of 
this,  the  number  of  meals  which  it  is  proper  to  take 
in  a  day,  much  difference  of  opinion  and  of  practice 
prevails.  It  seems  to  me  unfortunate  that  many  of 
the  data  as  to  the  time  that  food  remains  in  the 
stomach  before  it  is  passed  in  a  partially  digested 
form  through  the  pylorus  into  the  small  intestine, 
have  been  obtained  from  the  experiments  of  Dr. 
Beaumont  on  the  stomach  of  St.  Martin.  St. 
Martin  was  a  young  Canadian  who,  about  1830, 
received  a  gun-shot  wound  in  the  stomach.  This 
healed,  leaving,  however,  a  valvular  opening,  by 
means  of  which  it  was  possible  for  Dr.  Beaumont  to 
examine  at  various  times,  after  food  had  been  taken, 
what  amount  of  digestion  had  been  performed ;  and 
careful  observations  were  made  by  Dr.  Beaumont  on 
this  point.  Thus,  to  take  an  instance  :  "At  three 
o'clock  on  a  certain  day,  St.  Martin  dined  on  boiled 
dried  codfish,  potatoes,  parsnips,  bread,  and  drawn 
butter.  At  half-past  three  o'clock  Dr.  Beaumont 
examined  and  took  out  a  portion  about  half- 
digested  ;  the  potatoes  the  least  so.  The  fish  was 
broken  down  into  small  fiJ.aments  ;  the  bread  and 
parsnips  were  not  to  be  distinguished.  At  four 
o'clock,  examined  another  portion.  Very  few 
particles  remained  entire.  Some  of  the  few 
potatoes  were  distinctly  to  be  seen.  At  half-past 
four   o'clock   he   took   out   and    examined   another 


298 

portion  ;  all  completely  chymified.  At  five  o'clock, 
stomach  empty."  "  Dr.  Beaumont  constructed  a 
table  shewing  the  times  required  for  the  digestion 
of  all  usual  articles  of  food  in  St.  Martin's  stomach, 
and  in  his  gastric  fluid  taken  from  the  stomach. 
Among  the  substances  most  quickly  digested  were 
rice  and  tripe,  both  of  which  were  chymified  in  an 
hour  ;  eggs,  salmon,  trout,  apples,  and  venison,  were 
digested  in  an  hour  and  a  half;  tapioca,  barley, 
milk,  liver,  fish,  in  two  hours ;  turkey,  lamb, 
potatoes,  pig,  in  two  hours  and  a  half;  beef  and 
mutton  required  from  three  hours  to  three  and  a 
half,  and  both  were  more  digestible  than  veal ;  fowls 
were  like  mutton  in  their  degree  of  digestibility. 
Animal  substances  were,  in  general,  converted  into 
chyme  more  rapidly  than  vegetables."  I  do  not 
deny  or  question  the  statement  that  these  facts 
were  true  for  St.  Martin's  stomach ;  but  I  am  very 
sure  that  whoever  should  infer  that  because  they 
were  true  in  that  particular  case,  they  are  true  in 
general  in  the  case  of  the  average  man  living  in  a 
town  and  doing  a  townsman's  work,  would  make  a 
very  great  mistake.  The  cases  are  not  comparable. 
We  ought  not  to  assume  that  the  activity  of 
digestion  in  a  young  Canadian  backwoodsman, 
living  an  active  and  even  laborious  life  in  the 
country,  will  be  parallelled  by  the  processes 
occurring  in  the  digestive  apparatus  of  a  man 
doing  office  work  or  the  work  of  a  business  man 
in  a  town.  Whoever  should  imagine  that,  because 
the  backwoodsman's  stomach  was  completely  empty 


299 

in  two  hours,  of  a  meal  of  codfish,  potatoes,  parsnips 
and  bread,  the  same  rapidity  might  be  expected  in 
a  townsman,  would  make  a  disastrous  mistake. 
According  to  that,  it  would  be  quite  justifiable  to 
eat  in  four  hours  again,  that  is,  at  seven  o'clock ; 
and  this  would  allow  two  hours  for  the  chyme  to 
become  chyle,  and  to  get  into  the  blood  and  be  used 
there.  Perhaps,  even  in  this  case,  five  hours  would 
be  a  better  interval  between  meals  than  four,  since 
-we  do  not  know  quite  how  long  a  time  the  latter 
processes  require  for  accomplishment,  and  it  is 
well  not  to  overload  the  digestion  or  to  clog  the 
lymph-separating  processes.  But  there  is  the  most 
unmistakeable  evidence  that  such  a  meal  as  St. 
Martin  took  is,  in  many  cases,  not  out  of  the 
stomach  of  a  townsman  for  five  or  six  hours  after  it 
is  taken ;  and  I  have  known  it  longer.  For  instance, 
I  have  seen,  and  that  not  once  but  many  times, 
food  eructated  from  the  stomach,  and  in  such  a 
condition  as  that  some  of  the  different  materials  of 
the  meal  could  be  distinguished  from  one  another, 
quite  six  hours  after  it  had  been  taken.  Food 
taken  at  two  o'clock,  for  instance,  has  been  seen  by 
me  even  as  late  as  eight  o'clock,  and  parsnips  in 
particular  have  been  observed.  There  is  a  minority 
of  persons  who  eructate  their  food  for  hours  after 
they  eat  it,  performing  a  process  not  very  unlike  the 
chewing  of  the  cud  in  herbivorous  animals ;  and  I 
have  had  more  than  one  such  person  under  observa- 
tion for  long  periods  of  time,  so  that  I  know  that  in 
such  persons  it  is  the  rule  that  stomach  digestion 


300 

requires,  not  two  hours,  as  in  St.  Martin's  case,  nor 
even  three  or  four  hours,  but  five  or  six  hours,  or 
even  longer  in  some  cases.  01  course,  I  do  not 
mean  that  no  food  leaves  the  stomach  for  the 
intestines  under  this  length  of  time.  The  fatigue, 
sudden  sometimes,  which  is  so  noticeable  three  or 
four  hours  after  a  full  meal,  whose  explanation  is 
given  later,  shews  that  some  of  the  food  must  do  so, 
but  in  such  persons,  not  infrequently  the  whole  of 
the  food  taken  at  a  meal  such  as  dinner,  has  not  left 
the  stomach  for  quite  five  or  six  hours,  or  even 
longer.  In  pathological  conditions  the  time  is  often 
much  longer  than  this.  I  have  known  food  to  be  in 
the  stomach  for  as  long  as  48  hours  ;  in  fact,  some 
sorts  of  foods,  as,  for  instance,  the  cocoanut,  which  is 
not  only  indigestible,  but  irritant  to  the  stomach, 
not  infrequently  require  this  length  of  time  for 
removal.  The  mushroom,  again,  which,  though 
indigestible  is  not  irritant,  but  bland,  not  infre- 
quently lies  in  the  stomach  for  24  hours  even  in 
normal  circumstances  ;  and  I  have  known  a  cup  of 
cocoa  lie  for  36  hours  in  atony  of  the  stomach,  a 
condition  of  disease,  of  course  ;  but  the  facts  as  to 
the  cocoanut  and  the  nmshroom  are  natural  and 
physiological  and  normal  in  many  instances.  I  saw 
on  one  occasion  in  a  patient  with  slow  digestion  (it 
is  true  the  salad  had  rather  too  much  vinegar  in  it), 
a  salad  which  had  been  eaten  at  7-30  p.m.,  vomited 
in  exactly  the  state  in  which  it  had  been  eaten,  so 
far  as  appearances  went,  at  five  o'clock  next  morning, 
or  say  nine  and  a   half  hours  after   it    had   been 


301 

taken.  The  curious  thing  was,  and  I  beheve  that 
this  is  not  at  all  an  uncommon  occurrence,  that  all 
the  other  articles  of  food  taken  at  7-30  appeared  to 
have  left  the  stomach,  since  none  of  them  were 
recognised.  It  appears  to  me  from  this  and  other 
like  experiences,  that  the  stomach  has  the  power  of 
selecting  what  it  can  digest,  of  digesting  it,  and  of 
passing  it  through  the  pylorus  into  the  small 
intestine,  while  it  retains  within  its  walls  other  and 
undigested,  and  perhaps  we  may  say,  also,  indigest- 
ible, foods.  But  if,  as  in  the  previous  case,  we  add 
three  hours  as  the  time  required  for  food  which  has 
left  the  stomach  to  get  into  the  blood,  so  as  to  be 
used  there  for  purposes  of  nutrition,  and  if  we  take 
even  the  shorter  period  of  five  hours  as  that 
required  for  complete  chymification  by  the  stomach, 
persons  whose  digestion  is  so  slow  as  this  ought  not 
to  eat  again  for  at  least  eight  hours  after  their 
previous  meal  was  taken  ;  and  I  believe  that  even  a 
longer  interval  is  often  demanded  if  health  is  to  be 
maintained.  Such  persons  might  eat,  e.g.,  at  eight 
a.m.  and  four  or  five  p.m.,  and  would  generally  be 
well  nourished  on  two  meals  a  day.  In  fact,  I  have 
often  recommended  men,  whose  digestion  is  so  slow 
as  this  (and  it  is  a  much  commoner  case  than  is 
usually  supposed),  to  eat  not  even  twice  a  day,  but 
once  only,  so  as  to  let  the  digestion  of  one  meal  be 
completely  effected,  both  its  primary  digestion  in 
the  stomach  and  intestines,  and  the  secondary 
digestion  or  lymph  assimilation  in  the  tissues, 
before   the   next   one   is   taken.      I    have   also   to 


302 

add  that  in  the  cases  in  which  this  advice  has 
been  accepted  and  acted  upon,  much  benefit 
has  accrued  to  health  and  vigour  in  almost 
every  instance.  I  have  recommended  this  course 
at  all  adult  ages,  up  to  86  even,  and  with  great 
benefit.  I  have  not  prohibited  a  hot  drink  of  tea, 
coffee  or  cocoa  twice  a  day  in  addition,  but  have 
preferred  that  it  should  be  taken  without  any  bread, 
or  perhaps  with  half  an  ounce  only.  An  interesting 
and  somewhat  curious  thing  in  reference  to  tea  and 
cofiee  in  this  connection  has  been  the  fact  that 
while  persons  living  on  the  ordinary  three  or  four 
daily  meals  have  alleged  that  they  could  not  take 
tea  or  coifee  after  five  p.m.  without  lying  awake 
till  three  or  four  in  the  morning ;  after  they  have 
gone  on  to  one  daily  meal  the  same  persons  can 
sleep  soundly  on  tea  or  coffee  taken  as  late  as  eight 
or  nine  or  even  ten  p.m.  Similar  interesting  and 
curious  facts  have  appeared  in  regard  to  other 
articles  of  food.  Thus  many  persons  think  they 
cannot  take  cheese  because  of  its  disagreeing  with 
them,  or  because  it  constipates  them  when  they  live 
on  three  or  four  daily  meals.  But  the  same  persons, 
on  becoming  monositeous,  or  taking  only  one  daily 
meal,  have  found  that  they  could  quite  well  take 
an  ounce  or  even  two  ounces  of  cheese,  without 
discomfort,  and,  more  remarkable  still,  have  thought 
that,  in  place  of  causing  constipation,  it  helped  the 
action  of  the  bowels.  This  kind  of  experience  it  is 
which  has  gone  towards  forming  in  my  mind  the 
conclusion  that  it  is  not  this,  that,    or   the   other 


303 

article  of  diet  which  makes  us  well  or  ill,  but  that 
health  or  discomfort  depends  rather  on  how  much 
we  take,  and  how  often  we  take  our  food. 

While  I  am  on  this  subject,  I  perhaps  ought  to 
mention  that  although  the  recommendation  to  eat 
once   a   day   only   has   for   the   most   part   in   my 
practice  been  offered  to  persons  after  middle  life,  as 
being  most  suitable  to  the  condition  of  those  whose 
bodily  frames  have   been   fully   grown,    and  often, 
indeed,    over-grown,    it    has    not   been   altogether 
confined    to    them.      I    have    often  recommended 
children   to   eat   twice    a    day,    and    always   with 
advantage ;    and  in   one   case   I   recommended  the 
mother  of  a  child  of  four  years,  who  was  suffering 
from  a  tuberculous  disease  of  the  knee  joint,   with 
suppuration   in  the  joint  and  necrosis  (or   limited 
death)  of  the  thigh  bone,  to  let  her  have  only  one 
meal  a  day ;    and  that  with   the   best   results.     I 
ought   to  say  that  the  child  had  also  a  glass  of 
milk  each  morning  and  each  evening,  but  no  solid 
food  at  either  of  these  times.     Milk  is,  no  doubt, 
food,  but   the  number  of   calories   represented  by 
a  glass  of  it  is  only  about   140,  so  that  the  two 
glasses  represented  about  280  calories.     According 
to  the  latest  authorities,  a  child  of  four  years  of 
age  ought  to  have  such  a  quantity  of  food  as  will 
produce  1200   to   1400  calories  daily,  so  that   280 
calories  represent  only  a  very  small  proportion  of 
this.     The  child  to  whom  I  refer  had  only  as  much 
food  as  would  produce  at  most  850  calories  when 
converted  into  energy  in  the  body,  and  probably 


304 

800,  or  even  less,  more  nearly  represented  the 
amount  which  she  did  have.  Nevertheless,  on  this 
diet,  which,  according  to  the  authorities,  was  a 
restricted  diet,  or  even  a  starvation  diet,  but  which 
proved  to  be  nothing  of  the  kind,  the  child  grew 
nearly  ten  pounds  avoirdupois  in  weight  in  fifteen 
months  ;  her  bowels,  which  had  been  constipated, 
became  perfectly  regular  ;  and  the  suppuration  in 
her  knee  joint  was  entirely  healed.  Could  anything 
shew  more  strikingly  than  this  case  that  the  quantity 
of  food  recommended  by  the  physiologists  working 
in  laboratories  is  much  greater  than  is  required  by  a 
child  in  actual  or  real  life  ?  Among  a  large  number 
of  criticisms  which  the  publication  of  this  case 
called  forth,  most  of  them,  strange  to  say,  laudatory 
(but  general  opinion  is,  I  think,  fast  altering  on  this 
subject,  and  people  are  at  least  not  so  intolerant 
and  contemptuous  as  they  used  to  be,  and  that  not 
long  ago,  of  views  such  as  I  am  here  advocating),  I 
received  one  from  a  medical  friend  of  over  30  years' 
standing  in  the  profession,  and  he  suggested  that  I 
had  given  the  child  not  too  little  but  too  much  !  ! 
I  had  myself  hinted  in  my  pamphlet  on  the  subject, 
that,  much  as  I  had  restricted  the  child's  diet,  who 
had  had  little  more  than  half  of  what  the  latest 
authority  said  she  ought  to  have  had  (and  this 
treatment  had  been  continued  for  fifteen  months),  1 
doubted  if  I  had  restricted  it  sufiiciently.  Dr. 
Haddon  wrote  to  say  that  in  his  opinion  I  had  given 
her  more  than  she  required.  I  must  say  that  I 
agree  with  him,  but  if  this  is  a  correct  view,  how 


305 

flagrantly  out  must  be  the  physiological  authorities 
who  recommend  so  very  much  more.  The  difierence 
between  us  is  not  as  to  a  little  less  or  a  little  more, 
but  it  is  a  difl'erence  of  two  to  one,  or  even  perhaps 
three  to  one.  Well  might  Hippocrates  say  that 
the  issue  could  not  be  determined  to  a  nicety. 
Apparently  it  cannot  be  determined  at  all — but  this 
is  absurd.  One  of  the  estimates  must  be  so  far 
away  from  nature  as  to  be  wrong.  Which  is  it? 
Day  and  night  no  doubt  shade  off  into  one  another 
by  insensible  gradations,  so  that  at  a  given  point  of 
time  it  is  diJBScult  to  know  whether  it  is  day  or 
night.  But  for  all  that,  the  ordinary  man  and  the 
ordinary  child  has  no  practical  difficulty  in  distin- 
guishing between  the  light  of  day  and  the  darkness 
of  night,  and  doctors  and  physiologists  (for  the 
practice  of  medicine  is  or  ought  to  be — I  repeat 
it  —  only  applied  physiology,  and  pathology  is 
only  disordered  physiology,  or  at  least  is  mainly 
so)  ought  to  be  able  to  come  nearer  to  a 
practical  conclusion  as  to  whether  a  child  ought 
to  have  for  health  as  much  food  as  is  represented 
by  1400  grand  calories,  or  only  by  as  much  as 
800  or  700  or  600  or  500  a  day.  It  is  said 
of  the  great  Hippocrates  himself  that  he  entirely 
failed  to  please  all  parties.  No  sensible  or  self- 
respecting  man  would  try.  On  one  occasion,  being 
accused,  however,  by  one  party,  of  feeding  patients 
to  death,  and,  by  another,  of  starving  them  to 
death,  he  made  no  reply,  but  allowed  the  one 
criticism  to   answer  the  other.     The  medical  man 


306 

who  to-day  attempts  to  hit  the  golden  mean  of 
moderation  between  too  much  and  too  little,  will 
probably  fail  to  please  either  party,  one  of  whom 
will  be  apt  to  say  one  thing  of  him,  and  the  other 
the  opposite  ;  but  he  may  take  comfort  in  the 
reflection  that  he  finds  himself  in  the  good  company 
of  those  who  in  the  past  have  attempted  the  same 
task ;  and  he  may  also  anticipate  that,  in  the 
future,  the  history  of  his  eiforts,  and  perhaps  his 
failures,  will  comfort  the  heart  and  cheer  the 
courage  of  successors  who  will  find  themselves 
attempting  the  same  arduous  enterprise.  I  think 
in  this  matter  that  Dr.  Haddon  is  much  more  nearly 
correct  than  some  of  the  physiological  authorities, 
and  the  great  majority  of  the  medical  profession, 
who,  afraid  seemingly  to  verify  things  for  them- 
selves, so  slavishly  follow  their  lead.  The  happy 
issue  of  this  case  under  the  treatment  adopted,  a 
treatment  which  I  have  used  not  only  in  juvenile 
struma,  but  also,  and  that  much  more  than  once,  in 
senile  struma  also,  has  confirmed  me  in  the  view  I 
have  often  expressed,  that  the  most  successful 
treatment  of  tubercular  disease  is  that  founded  on 
the  view  that  its  management  is  analogous  to  the 
di-ainage  of  marshy  land  in  agriculture.  More 
water  is  getting  into  the  ground  than  is  flowing 
out,  and  the  problem  is,  for  a  time,  and  until 
proper  drainage  has  been  efiected,  to  allow  more  to 
get  out  than  flows  in,  after  which  time  proper 
drainage  must  be  resorted  to.  In  white  swelling  of 
the   knee    or   other   joints,    a    precisely   analogous 


I  307 

problem  presents  itself  for  solution,  for  much  more 
lymph  is  finding  its  way  into  the  joint  structures 
than  is  flowing  out,  and  the  problem  therefore  is, 
and  must  be  for  a  time,  and  until  a  proper  balance 
has  been  effected,  to  allow  more  lymph  to  get  out 
than  flows  in,  after  which  time  proper  feeding 
must  be  resorted  to.  If  this  view  is  in  collision 
with  the  present  orthodox  opinion,  fostered  and 
supported  by  that  love  of  indulgence,  and  of 
luxury,  and  of  short-lived  pleasure,  which  is  so 
characteristic  of  our  time,  the  orthodox  opinion 
that  cases  of  tuberculosis  ought  to  be  stuffed 
or  over-fed,  I  can  only  regret  that  such  evidence 
as  I  have  has  forced  me  to  a  different  conclusion. 
The  serious  question,  fraught  with  the  issues  of 
life  and  death,  and  of  maiming  or  soundness 
to  our  patients,  is,  which  view  is  nearer  to  the 
truth.  I  may  say  that  the  mother  of  the  child 
in  question,  finding  the  results  so  satisfactory 
in  one  child,  and  finding  that  an  elder  sister, 
though  three  years  older,  weighed  only  two 
pounds  more  than  the  younger  one,  and  finding 
that,  although  not  ill,  she  looked  pale  and 
anaemic  (triphthgemic  or  catatrib^mic,  rpCfieiv  =  to 
rub  or  waste)  of  her  own  accord  has  put  the  elder 
child  on  to  the  same  lines  of  treatment  as  the 
younger  one.  I  cannot  doubt  what  the  result 
will  be.  The  elder,  also,  will  get  a  better  colour 
and  gain  weight.  The  law  having  been  pointed  out 
and  declared  by  the  medical  interpreter  of  nature, 
all  that  the  patient  has  to  do  is  to  attempt  to  obey 

T2 


308 

it,  and  the  more  nearly  he  can  do  so,  the  better 
health  and  vigour  will  he  enjoy.  If  any  hitch 
arises  or  if  any  difficulty  occurs,  the  medical  expert 
may  again  be  consulted ;  but  his  proper  function 
must  in  that  case  again  be  to  clearly  point  out  the 
scope  of  the  law  and  clear  up  any  misconceptions  in 
its  interpretation.  All  that  the  doctor  can  do  is  to 
declare  the  law  ;  all  that  the  patient  can  do  is  to 
obey  it ;  and  the  more  nearly  the  patient  succeeds 
in  doing  this,  the  less  and  less  necessary  does 
the  medical  expert  become.  If  we  know  the 
formula  by  which  the  law  of  gravitation  acts  on  a 
falling  body,  we  do  not  need  a  mathamatician  or  a 
physical  expert  to  make  its  application  in  any  given 
case.  With  some  knowledge  of  arithmetic  we  can 
do  that  for  ourselves. 

The  complaint  which  patients  not  infrequently 
make  to  their  doctor,  of  feeling  tired  several  hours 
after  taking  a  meal,  may  now  be  shortly  considered. 
If,  for  instance,  they  dine  at  half  past  one  or  two 
o'clock,  they  feel  very  tired,  and  sometimes  rather 
suddenly  so,  especially  if  the  meal  has  been  a 
somewhat  full  and  large  one,  about  five  or  six 
o'clock.  How  is  this  they  ask  ?  Well,  the  explan- 
ation is  very  simple.  In  three  or  four  hours  after 
eating,  digestion  has  made  some  progress  towards 
effectiveness.  Chyle  from  the  food  has  begun  to  be 
poured  into  the  blood.  If  the  chyle  so  poured  into 
the  blood  bears  too  large  a  proportion  to  the  total 
volume  of  the  blood,  the  in-rush  is  too  great,  and 
when  the  blood,  laden  in  this  way  with  too  much 


309 

chyle  from  the  thoracic  duct,  finds  its  way  to  the 
muscles,  which,  as  we  saw  before,  may  contain  some 
30  per  cent,  of  the  blood  in  them,  they  become 
rather  suddenly  loaded  with  too  much  material,  and 
being  oppressed  with  this,  they  cry  out  as  if 
fatigued.  Especially  will  this  be  so,  if,  the  meal 
having  been  a  large  one,  it  has  not  been  very 
perfectly  assimilated.  The  chyle  in  this  case  will 
have  been  imperfectly  elaborated,  and  the  blood 
therefore  imperfectly  made.  The  blood,  finding 
itself  loaded  with  imperfectly  assimilated  stuff  from 
the  food,  will  begin  to  get  rid  of  it  into  the  muscle 
sheaths;  and  the  lymph  spaces,  being  somewhat 
choked  with  excess  of  lymph,  and  particularly  with 
excess  of  lymph  from  imperfectly  assimilated  food 
stuff,  the  lymph  vessels  will  not  carry  away  the 
lymph  plasma  sufficiently  quickly,  and,  as  a  certain 
amount  of  swelling  will  therefore  occur,  the  person 
will  feel  tired.  Neither  the  muscles  nor  their 
sheaths  will  work  smoothly  or  easily,  and  the 
sensation  of  fatigue  is  really  caused  mainly  because 
the  muscles  are  loaded  with  bad  blood  containing 
ptomaines  and  other  unassimilated  materials.  The 
blood  is  said  to  contain  uric  acid.  No  doubt  it 
often  does,  but  it  is  very  unlikely  that  uric  acid  is 
the  only  poison  carried  by  the  blood  to  the  tissues 
in  such  circumstances.  No  doubt  other  materials 
besides  uric  acid  are  present,  some  of  them  known 
to  chemists  as,  e.g.j  lactic  acid,  and  very  probably 
others  as  yet  unknown.  In  fact,  uric  acid  stands 
mainly  as  a  symbol  or  sign  of  imperfectly  oxidised 


310 

and  imperfectly  assimilated  products  of  digestion, 
and  it  is  these  in  their  totality  or  aggregate  which 
poison  and  fatigue  the  muscles  and  the  whole 
locomotor  mechanism.  But  the  blood  received  its 
excess  of  material,  too  much  in  volume  in  pro- 
portion to  its  total  capacity,  and  ill-assimilated 
besides,  from  the  thoracic  duct.  The  thoracic  duct 
in  turn  received  its  contents  from  the  chyle  of  the 
small  intestine.  (The  contents  of  the  thoracic  duct 
have  sometimes  been  described  as  the  lymph  from 
the  villi  of  the  small  intestine.  This  terminology 
is  illuminating,  and  instructive  of  it  makes  us  think 
of  the  meaning  of  the  purposes  which  lymph 
performs  in  the  body).  The  small  intestine  in  its 
turn  received  its  contents  from  the  stomach  through 
the  pylorus  ;  and  the  stomach  in  its  turn  received 
its  contents  by  the  oesophagus  or  gullet,  which 
conducted  the  food  often  far  too  quickly,  and  far 
too  imperfectly  masticated,  from  the  mouth.  The 
whole  processes  of  digestion  thus  hanging  together, 
and  being  dependent,  step  by  step,  and  each  step 
on  the  step  immediately  preceding  it,  too  much 
fatigue  after  eating,  whether  an  hour  after,  or  three 
or  four  hours  after,  which  is  a  far  commoner  experi- 
ence, calls  out  to  us  rather  (if  our  ears  are  attuned 
to  listen)  to  masticate  properly  and  to  eat  less,  than 
to  lie  down  for  an  hour  after  eating,  or  to  lie  down 
for  two  hours,  or  say  three  or  four  hours  after  food. 
And  when  at  5  or  6  o'clock  a  cup  of  afternoon 
tea  is  taken,  the  stimulus  it  gives  is  so  marked  as 
to  be  an  almost  universal  experience,  whose  good 


311 

effects,  if  people  would  but  make  the  experiment, 
would  be  as  beneficially  experienced,  and  much 
more  safely,  without  any  solid  food  being  added 
with  it. 

I  fear  I  shall  get  on  to  very  controversial 
ground  in  what  I  am  going  to  say  next.  I  do  not 
recommend  the  taking  of  alcoholic  stimulants  at 
all ;  but  if  they  are  taken,  I  recommend  the 
average  man  to  take  only  as  much  alcohol  as  would 
be  represented  by  one  small  glass  of  whiskey  twice  a 
day.  More  than  this  transcends  the  bounds  of  mod- 
eration. But  now  if  he  is  going  to  take  it,  say  at 
five  in  the  afternoon,  or  at  eleven  in  the  forenoon 
(not  so  suitable  a  time,  I  think),  if  he  is  going  to 
take  it,  ought  he  to  eat  with  it  ?  Well,  I  think 
not.  Why  should  he  eat  at  either  of  those  times  ? 
He  does  not  require  food  at  5  p.m.  if  he  has  had 
lunch  at  from  1  to  2  o'clock ;  and  if  he  does  not 
take  his  first  meal  till  12  or  1  o'clock,  he  still  ought 
not  to  eat  at  11,  because  whatever  he  eats  then  will 
certainly  not  be  digested  when  he  has  his  meal  at 
12,  or  1,  or  1-30.  The  same  reasons  which  justify 
the  advice  not  to  eat  with  afternoon  tea  compel 
one,  therefore,  to  offer  the  advice  that  if  a  person 
is  going  to  take  alcohol  either  at  11  a.m.,  or  5  or 
6  p.m.,  he  should  refrain  from  eating  at  those  times. 
It  seems  to  be  thought  that  if  a  man  eats  at  the 
same  time  that  he  takes  alcohol,  the  food  will 
prevent  the  alcohol  from  doing  his  stomach  so  much 
harm  as  if  he  takes  it  alone.  I  think,  however, 
that  this  reasoning  is  fallacious,  and  that  the  habit 


312 

of  too  frequent  eating,  which  such  practices 
confirm,  does  an  immense  amount  of  damage  by 
keeping  up  continual  demands  for  work  on  the  part 
of  the  digestive  organs.  If,  therefore,  a  man  does 
take  a  little  alcohol  at  either  of  those  times  (which 
I  do  not  recommend  him  to  do)  I  think  he  ought  not 
on  any  account  to  eat  at  those  times.  And  if  his 
second  ounce  of  whiskey  is  taken  at  bed-time,  as  it 
so  often  is,  I  for  the  same  reason  advise  him  not  to 
eat  biscuits  or  any  other  food  at  that  time. 
Frequent  eating  and  frequent  alcoholic  drinking 
are  two  very  bad  things,  but  it  is  certainly  more 
dangerous  for  a  man  or  woman  to  do  both 
together  than  it  is  to  do  one  alone. 

Another  question  which  patients  often  put  to 
their  doctors  is  this  :  Why  do  we,  they  will  say, 
wake  tired  in  the  morning  after  six,  seven,  or  eight 
hours'  sleep?  The  answer  to  this  question  need 
not  detain  us  long.  We  wake  tired  in  the  morning 
because  too  much  material  has  been  finding  its  way 
into  the  blood  from  the  digestion,  and  because  during 
the  quiet  of  sleep  the  blood  has  taken  the  opportunity 
to  drop  in  the  connective  tissue  that  excess  of 
material  which  was  oppressing  it.  As  the  connective 
tissue  forms  the  coverings  of  the  muscles,  bones,  joints 
and  nerves,  the  consequence  is  that  the  whole  loco- 
motor system  is  in  such  circumstances  over-loaded, 
so  that  whenever  we  begin  to  move  we  are  tired. 

o 

During  sleep  I  believe  the  veins  are  dilated,  and 
the  arteries  contracted.  The  longitudinal  elements 
of  the  former  vessels  are  stimulated  more  than  their 


313 

transverse  elements,  while  the  transverse  elements 
of  the  arteries  are  contracted  rather  more  than  the 
longitudinal.  (When  the  reverse  of  this  occurs,  i.e.^ 
when  the  arteries  are  dilated,  the  person  is  sleep- 
less). The  veins  being  thus  in  sleep  dilated  and 
full  of  blood,  which  is,  besides,  moving  rather 
sluggishly,  the  blood  has  every  facility  of  getting 
rid  of  any  material  it  may  contain  in  excess. 
Another  form  of  the  question  often  is  :  Why  do  we 
sleep  for  say  two  hours,  then  wake,  and  find 
ourselves  unable  to  sleep  again  for  say  two  or  three 
hours,  or  perhaps  not  at  all ;  or  perhaps  we  fall 
asleep  just  when  we  ought  to  be  getting  up?  And 
yet  another  form  of  the  question  may  be  :  How  is 
it  that  we  cannot  sleep  till  three,  four,  or  five  in  the 
morning  ?  And  still  another  form  of  the  question 
may  be  :  Why  do  we  sleep  too  heavily  ?  After  the 
discussions  in  Chapters  VI.  and  YII.  we  can  readily 
understand  that  defect  of  the  function  of  sleep, 
irregularity  of  that  function  and  excess  of  it,  are 
all  due  to  the  same  cause,  viz.,  that  we  are  eating 
too  much  or  too  often,  or  that  we  are  eating  too 
much  and  too  often.  I  do  not  know  if  my  explana- 
tion of  the  respective  state  of  the  veins  and 
arteries  in  sleep  is  correct  or  not,  although  I  think 
it  is.  I  consulted  an  eminent  physiologist  on  the 
point,  and  he  said  it  was  a  very  difficult  question  to 
answer.  But  it  does  not  really  matter  whether  the 
precise  explanation  offered  is  the  correct  one. 
What  does  matter  is  that  during  sleep  the  blood 
does  part  to  the   connective   tissue   with   materials 


314 

which  it  coutains  beyond  its  needs,  and  that  this 
physiological  fact  accounts  for  the  feeling  of  fatigue 
which  many  persons  experience  on  waking  in  the 
morning.  The  connective  tissue  is  what  we  may 
call  the  dumping  ground  of  the  blood  ;  it  is  the 
safest  or  the  least  hurtful  place  in  which  waste 
products  can  be  deposited,  for  if  they  were  not 
deposited  in  the  ilemmatous  parts  of  organs,  they 
might  be  dropped  into  the  parenchymatous  portions, 
in  which  case,  instead  of  being  tired  simply,  we 
might  get  an  attack  of  pneumonia.  As  the  muscle 
sheaths,  the  bone  coverings,  or  periosteum,  the 
joint  ligaments,  and  the  nerve  sheaths,  as  also  the 
brain-and  cord-membranes  are  all  made  of  this 
connective  tissue,  all  the  locomotor  system  is 
oppressed  and  weighted  by  being  thus  made  the 
dumping  ground  of  the  blood,  and  therefore  when- 
ever one  moves  after  waking  in  the  morning,  one 
feels  and  must  feel  tired.  There  is  really  inflam- 
mation or  at  least  congestion  all  over  the  body,  for  the 
connective-tissue  is  found  practically  everywhere  in 
the  body.  No  wonder,  therefore,  that  the  body  is 
tired.  Every  movement  is  clogged,  and  the  patient 
feels  as  if  she  could  not  drag  one  leg  behind  the 
other.  I  have  suggested  that  this  condition  should 
be  called  Initis,  from  the  Greek  \a,  Latin  vis  = 
strength.  Homer  used  the  word  Iviov,  as  did  also 
Hippocrates,  of  the  strong,  firm  elastic  tissue  at  the 
nape  of  the  neck,  the  same  which,  immensely 
strengthened  in  the  horse,  for  example,  enables  it  to 
carry  its  heavy  load  almost  at  right  angles  to  its 


315 

body  (or  take  the  elephant  as  even  a  more  striking 
example),  seemingly  without  getting  tired  or 
knowing  even  that  it  has  such  a  heavy  weight 
to  carry.  Even  in  man,  however,  the  tissue  is 
strong ;  and  a  marked  sign  of  advancing  age  and  of 
danger  to  life  is  noticed  when  this  strong  tissue 
begins  to  get  weak,  and  the  head  begins  to  shake 
or  tremble  on  the  neck.  Old  persons  seldom  last 
more  than  two  years,  I  have  observed,  after 
beginning  to  manifest  this  sign.  Sometimes  the 
affection  of  the  connective  tissue  in  young  people  is 
called  hysteria,  sometimes  neurastheniaj  sometimes 
neuralgia,  and  sometimes  women  (for  it  is  oftenest 
observed  in  them)  are  reproached  with  being  able 
to  avoid  complaining  if  they  would ;  and  sometimes, 
I  regret  to  say,  are  recommended  to  undergo  many 
and  varied  mutilating  and  other  operations  on 
account  of  it,  which  operations  do  not  and  cannot 
cure  them,  A  further  stage  of  initis,  or  inflamma- 
tion of  the  connective  tissue,  as  it  is  the  further 
stage  of  all  other  inflammations,  is  effusion  of  fluid, 
sometimes  into  joints,  when  it  is  called  synovitis,  or 
if  many  joints  are  affected,  rheumatic  fever ;  or  if 
the  effusion  takes  place  into  the  pleura,  it  is  called 
pleurisy;  or  if  into  the  peritoneum,  it  is  called 
peritonitis  ;  or  if  into  the  brain  membranes  it  causes 
coma,  or  unconsciousness,  with  dilated  pupils,  and 
perhaps  death.  It  is  quite  true  that  these  very 
serious  developments  occur  only  rarely,  but  they 
do  occur  often  enough  to  make  practitioners  wary, 
and  the  older  a  doctor  gets  the  less  lightly  does  he 


314 

which  it  coutains  beyond  its  needs,  and  that  this 
physiological  fact  accounts  for  the  feeling  of  fatigue 
which  many  persons  experience  on  waking  in  the 
morning.  The  connective  tissue  is  what  we  may 
call  the  dumping  ground  of  the  blood  ;  it  is  the 
safest  or  the  least  hurtful  place  in  which  waste 
products  can  be  deposited,  for  if  they  were  not 
deposited  in  the  ilemmatous  parts  of  organs,  they 
might  be  dropped  into  the  parenchymatous  portions, 
in  which  case,  instead  of  being  tired  simply,  we 
might  get  an  attack  of  pneumonia.  As  the  muscle 
sheaths,  the  bone  coverings,  or  periosteum,  the 
joint  ligaments,  and  the  nerve  sheaths,  as  also  the 
brain-and  cord-membranes  are  all  made  of  this 
connective  tissue,  all  the  locomotor  system  is 
oppressed  and  weighted  by  being  thus  made  the 
dumping  ground  of  the  blood,  and  therefore  when- 
ever one  moves  after  waking  in  the  morning,  one 
feels  and  must  feel  tired.  There  is  really  inflam- 
mation or  at  least  congestion  all  over  the  body,  for  the 
connective-tissue  is  found  practically  everywhere  in 
the  body.  No  wonder,  therefore,  that  the  body  is 
tired.  Every  movement  is  clogged,  and  the  patient 
feels  as  if  she  could  not  drag  one  leg  behind  the 
other.  I  have  suggested  that  this  condition  should 
be  called  Initis,  from  the  Greek  tcr,  Latin  vis  = 
strength.  Homer  used  the  word  Iviov,  as  did  also 
Hippocrates,  of  the  strong,  firm  elastic  tissue  at  the 
nape  of  the  neck,  the  same  which,  immensely 
strengthened  in  the  horse,  for  example,  enables  it  to 
carry  its  heavy  load  almost  at  right  angles  to  its 


315 

body  (or  take  the  elephant  as  even  a  more  striking 
example),  seemingly  without  getting  tired  or 
knowing  even  that  it  has  such  a  heavy  weight 
to  carry.  Even  in  man,  however,  the  tissue  is 
strong ;  and  a  marked  sign  of  advancing  age  and  of 
danger  to  life  is  noticed  when  this  strong  tissue 
begins  to  get  weak,  and  the  head  begins  to  shake 
or  tremble  on  the  neck.  Old  persons  seldom  last 
more  than  two  years,  I  have  observed,  after 
beginning  to  manifest  this  sign.  Sometimes  the 
affection  of  the  connective  tissue  in  young  people  is 
called  hysteriuj  sometimes  neurastheniaj  sometimes 
neuralgia,  and  sometimes  women  (for  it  is  oftenest 
observed  in  them)  are  reproached  with  being  able 
to  avoid  complaining  if  they  would  ;  and  sometimes, 
I  regret  to  say,  are  recommended  to  undergo  many 
and  varied  mutilating  and  other  operations  on 
account  of  it,  which  operations  do  not  and  cannot 
cure  them,  A  further  stage  of  initis,  or  inflamma- 
tion of  the  connective  tissue,  as  it  is  the  further 
stage  of  all  other  inflammations,  is  effusion  of  fluid, 
sometimes  into  joints,  when  it  is  called  synovitisj  or 
if  many  joints  are  affected,  rheumatic  fever ;  or  if 
the  effusion  takes  place  into  the  pleura,  it  is  called 
pleurisy ;  or  if  into  the  peritoneum,  it  is  called 
peritonitis  ;  or  if  into  the  brain  membranes  it  causes 
coma,  or  unconsciousness,  with  dilated  pupils,  and 
perhaps  death.  It  is  quite  true  that  these  very 
serious  developments  occur  only  rarely,  but  they 
do  occur  often  enough  to  make  practitioners  wary, 
and  the  older  a  doctor  gets  the  less  lightly  does  he 


316 

tend  to  treat  those  so-called  hysterical  affections, 
even  although  very  few  seem  to  have  made  out  the 
pathology  of  them  ;  for  every  experienced  doctor 
must  once  or  oftener  have  been  compelled  to  see  a 
calamitous  issue  to  cases  of  this  kind.  And  if  he 
has  spoken  slightingly  of  the  case,  and  has 
suggested,  for  instance,  that  the  young  woman 
should  have  water  poured  from  a  jug  on  her  upper 
lip  between  her  nose  and  mouth,  so  as  that  by 
preventing  her  from  breathing  properly  she  may  be 
roused  out  of  her  "  hysterical  "  state,  and  if  she 
should  unhappily  become  comatose  and  die,  his 
credit  is  severely  diminished  and  justly  impaired, 
and  the  value  of  his  advice  to  the  friends  not  to 
make  too  much  of  the  ailment,  and  "  not  to  be  too 
sympathetic,"  is  severely  called  in  question.  For 
the  curious  thing  about  these  cases  is  their 
variability.  Sometimes  the  women  who  suffer  in 
this  way  are  now  quite  well,  and  then  again,  and 
that  in  a  short  time,  very  ill.  Alterations  in  the 
circulation  of  the  blood,  and  particularly,  I  think, 
of  the  lymph,  alterations  which  may  and  do  occur 
suddenly  and  extensively  and  unexpectedly,  make 
the  women  now  very  ill  when  connective-tissue- 
lymph-congestion  occurs,  and  in  a  short  time  they 
seem  to  be  much  better  again,  when  connective- 
tissue-lymph-relief  occurs  ;  and  the  alternation  of 
these  processes  taking  place  at  short  intervals  of 
time,  gives  to  the  disease  that  erratic  character 
which  has  led  to  so  many  mistakes  being  made 
about  it.     It  seems  to  me  to  be  a  very  simple  thing 


317 

to  understand  it,  and,  understanding  it,  to  treat 
and  cure.  Unhappily,  the  advice  which  is  good 
for  it  goes  against  popular,  and,  worse  still,  against 
professional  opinion,  so  that  on  all  sides,  from 
s^nnpathetic  and  well  -  meaning  but  injudicious 
friends  on  the  one  hand,  and  because  the  medical 
profession  do  not  always  seem  to  have  clear  ideas 
regarding  either  the  nature  of  the  affection  or  its 
cure  on  the  other,  the  patient  is  dissuaded  from 
taking  the  advice  to  restrict  her  diet,  which,  never- 
theless, is  the  only  advice  (that  and  gentle  and 
cautiously  increased  exercises)  that  can  do  her  any 
good.  Pain  between  the  shoulders  (the  muscles  of 
the  back  being  sore  and  tender)  and  in  other  parts 
of  the  body,  and  what  is  very  badly  called  anaemia 
or  chlorosis,  are  frequently  concomitant  conditions. 
Also,  as  we  saw  before,  we  find  constipation  present, 
which  is  too  frequently  treated  as  if  it  were  the 
substantive  affection,  whereas,  in  fact,  it  is  a  con- 
comitant condition,  due,  as  we  then  saw,  to  the 
same  plugging  or  blocking  of  the  lymph  circulation 
in  the  intestine,  which,  when  it  exists  in  the  brain- 
connective-tissue,  causes  all  the  flightiness  and 
disorder  of  mind  and  body  which  characterise  this 
very  grave  and  by  no  means  imaginary  complaint. 
Recurring  headaches,  megrim,  neuralgias,  &c.,  &c., 
also  often  characterise  it,  very  diJfficult  to  understand 
when  improperly  viewed,  and  yet  so  simple  and  so 
easy  to  treat  and  to  cure  when  one  can  manage  to 
persuade  patients,  and  particularly  to  persuade  their 
friends,  to  allow  to  be  used  the  only  means  that  are 


318 

suitable  for  them.  lu  some  cases  iDdigestion  is  the 
most  prominent  sign,  and  it  is  happy  when  this  is 
so,  for  then  there  is  some  chance  that  the  patient 
and  her  friends  will  submit  to  treatment ;  and  also 
the  medical  adviser  has  his  attention  perforce 
directed  to  the  real  cause  of  the  ailment,  which 
manifests  itself  in  so  many  and  varied  and  protean 
forms  and  symptoms.  Cases  of  this  kind  are  the 
despair  at  once  of  the  public  and  of  the  medical 
profession,  and  yet  they  are  easily  treated  when 
properly  handled.  Such  a  case  I  saw  recently 
in  a  young  woman  (like  all  my  colleagues  I  have 
seen  scores,  perhaps  hundreds,  of  them  —  they 
are  very  common  indeed),  and  handled  with 
perfect  success,  by  persuading  her  relatives  to 
allow  her  to  be  submitted  to  a  much  restricted  diet 
for  a  fortnight,  that  is  to  say,  the  whey  from  one 
pint  of  milk  daily,  after  which,  for  another 
fortnight,  she  was  put  on  one  meal  a  day,  and 
recommended  to  have  exercises  first  once  and  then 
twice  a  day  ;  and  for  the  third  fortnight  she  was 
allowed  two  meals  a  day,  the  first  at  12  noon,  and 
the  second  at  7  p.m.  I  also  ordered  a  large  linseed 
meal  poultice  to  be  put  over  the  abdomen  for  an  hour 
morning  and  evening  at  first,  and  afterwards  in  the 
evening  only.  The  girl,  who  had  been  ill  for  years, 
was  entirely  reasonable  herself,  and  having  suffered 
so  much  and  so  long,  was  only  too  glad  to  submit 
to  any  treatment  likely  to  benefit  her.  It  was  the 
dyspeptic  form  of  hysteria  (or,  as  I  prefer  to  call  it, 
initis),    from    which    she    sufiered.      She    vomited 


319 

everything  she  took,  or  almost  everything,  and  was 
thin,  pale,  emaciated,  and  anaemic  (triphthsemic)  ; 
she  was  suffering,  in  fact,  from  indirect  starvation, 
the  proper  treatment  of  which  is,  at  first, 
restriction  of  the  diet,  as  we  have  seen,  and  then 
cautiously  increased  feeding  as  the  patient  can 
bear  it.  It  is  really  one  of  the  simplest  things 
to  understand  and  to  treat  if  only  it  is  properly 
viewed,  but,  when  improperly  viewed,  one  of  the 
miost  difficult  and  the  most  intractable.  But,  in 
one  word,  the  common  error  concerning  it  is  the 
mistaking  of  indirect  for  direct  starvation,  and  the 
treating,  therefore,  by  increase  of  food  what  ought 
to  be  treated  by  restriction.  It  is  a  very  serious 
error,  which  even  experts  sometimes  fall  into. 
When  the  head  is  very  much  affected  in  some  of 
these  cases,  the  connective  tissue  about  the  brain 
being  much  irritated,  patients  not  infrequently  lose 
the  balance  of  their  minds  and  reason,  and  even 
have  to  be  put  under  care.  Unreasonableness, 
flightiness,  uncertainty  of  disposition,  a  mixture  of 
amiability  and  perversity,  and  a  curiously  subtle 
power  to  excuse  and  defend  eccentricity,  and  to 
make  the  worse  appear  the  better  reason,  char- 
acterise the  mental  condition  of  persons  suffering  in 
this  way  ;  added  to  which  is  often  found  a  morbid 
desire  to  nurse  and  even  create  grievances,  some  of 
the  women  seeming  never  to  be  happy  unless  they 
have  a  grievance.  Sometimes  love  is  said  to  make 
them  go  wrong,  sometimes  religion.  The  fact  is, 
they    are    so    disturbed    that   anything   would   or- 


320 

might  have  upset  the  balance.  Love  or  reUgion 
may  be  the  occasion,  no  doubt,  but  the  condition  of* 
the  nutrition  is  the  main  cause.  The  connective 
tissue  inside  the  head  has  become  congested  from 
improper  nutrition,  and  has  irritated  the  brain  cells, 
preventing  their  healthy  action.  I  mention  this 
here  particularly  because  so  much  good  can  often  be 
done  in  such  cases  by  restriction  of  the  diet.  I 
have  already  mentioned  the  case  of  a  lady  who 
recovered  rapidly  when  she  braced  herself  up  to 
follow  the  advice  given  her  ,to  stop  the  inordinate 
quantities  of  sweets  which  she  had  been  in  the 
habit  of  taking.  And  I  have  also  referred  at  some 
length  to  Dr.  Dewey's  case,  in  which  a  lady  fasted 
for  45  days,  so  restoring  herself  to  perfect  sanity. 
These  cases  emphasize  the  question  asked  by  Dr. 
Dewey,  whether  we  might  not  anticipate  better 
results  than  we  now  obtain  if  we  treated  insanity 
more  frequently  by  restriction  of  the  diet.  Cer- 
tainly no  patients  could  be  so  thoroughly  controlled 
as  patients  in  asylums,  and  it  would  always  be  easy 
to  interfere  if  there  seemed  to  be  any  danger  to  life 
from  direct  starvation.  Sometimes,  no  doubt,  the 
connective  tissue  in  other  parts  of  the  body,  as,  for 
instance,  the  pelvis,  is  inflamed  also  in  these  initio 
affections.  It  is  natural  that  it  should  be.  The 
same  blood  goes  everywhere  in  the  body,  and,  being 
badly  made  and  loaded  with  unused  stuff,  may 
deposit  this  stuff,  or  some  of  it,  in  the  connective 
tissue,  wherever  connective  tissue  exists,  and 
therefore  in  the  pelvis,   causing   various  adhesions 


321 

and  inflammations  of  the  organs  in  this  region  of 
the  body,  or  even  sometimes  going  on  to  suppur- 
ation. But  even  such  adhesions  do  not  justify 
naany  of  the  surgical  operations  which  are 
performed  for  their  rehef,  and  certainly  do  not 
justify  the  mutilating  operations  on  women  which 
are  so  common  nowadays.  The  medical  manage- 
ment referred  to  will  nearly  always  in  young 
women  succeed  in  removing  these  adhesions, 
displacements,  &c.,  if  patients  wiU  be  patient  and 
intelligent  as  to  their  causation.  And  if  operation 
is  necessary,  it  is  very  seldom  indeed  that  removal 
of  organs  is  called  for,  especially  as  such  removal 
too  often  fails  to  cure  the  complaints  from  which 
patients  suffer.  Evidently,  unless  something  is 
said  as  to  causation,  the  same  processes  must  go  on 
in  the  body,  and  must  result  in  disease  somewhere 
else,  even  if  the  particularly  distressed  part  has 
been  removed. 

One  other  condition  found  in  many  of  these 
initio  cases  I  must  not  omit  to  mention,  viz.,  the 
tendency  often  shewn  to  bruise  easily.  On  the 
slightest  occasion,  as,  for  example,  if  they  happen 
to  knock  against  a  piece  of  furniture,  or  if  they 
sustain  some  very  slight  injury,  and  sometimes  even 
when  no  history  of  injury  can  be  made  out,  women 
will  shew  large  black  or  blue  bruises  on  various 
parts  of  their  bodies.  Sometimes,  if  a  friend  lays 
a  hand  upon  them,  takes  hold  of  an  arm,  for 
example,  the  finger  marks  may  appear  next  day. 
This  condition  was  well  known  to  the  ancient 
u 


322 

writers  on  medicine,  and  the  Greeks  called  it 
peliosis  or  pelidnosis  (TreXtos  =  black  and  blue, 
livid),  but  I  am  not  aware  what  explanation  they 
gave  of  it,  or  if  they  gave  any.  It  is  evidently 
due  to  excessive  weakness  or  to  a  very  low  degree 
of  resistance  in  the  connective  tissue  of  the  body, 
the  coats  of  the  finest  blood-vessels  being  so  weak 
as  to  become  lacerated  on  sustaining  the  slightest 
injury  or  tension.  Kupturing,  they  cause  extrava- 
sation of  a  minute  amount  of  blood  into  the  cuUular 
tissue  of  the  body  ;  and  it  is  the  changes  undergone 
by  this  blood  in  the  course  of  its  re-absorption 
which  cause  the  discoloration  and  lividity  referred 
to.  But  what  is  the  cause  of  the  excessive  weak- 
ness of  the  connective  tissue  which  makes  it  give 
way  so  readily  ?  Well,  the  cause  is  the  one  we 
have  so  often  seen  in  action,  mal-nutrition ;  which, 
in  nearly  all  cases,  means  over- nutrition  of  the 
connective  tissue,  and  congestion  of  the  blood  and 
lymph  circulation  by  the  ingestion  of  (generally) 
small  meals,  too  frequently  repeated.  This  condi- 
tion often  coincides  with  the  somewhat  flighty  and 
irregular  mental  condition  to  which  I  have  already 
referred ;  and,  indeed,  women  so  improperly  nourished 
not  injfrequently  convert  injuries  sustained  in  the 
trivial  ways  described  into  proofs  of  cruelty,  and 
shew  them  as  evidence  in  accusations  of  ill-treatment. 
To  advise  persons  suffering  in  this  way  to  eat,  not 
little  and  often,  but  little  and  seldom,  if  they  want 
to  be  well  in  the  comparatively  inactive  life  which 
many  of  them  lead,  sounds,  I  have  often  been  made 


323 

to  feel,  like  adding  insult  to  injury,  but  is,  never- 
theless, I  regret  to  say,  the  only  advice  which  can 
do  them  any  good.  The  exercises  which  one  might 
otherwise  be  disposed  to  recommend,  they  not 
infrequently  cannot  bear ;  in  fact,  such  movements 
might  only  increase  the  evil,  and  the  only  thing  left 
is  that  they  should  be  advised  to  restrict  their  diet. 
The  conclusions,  then,  which  seem  reasonable 
from  the  evidence  and  considerations  advanced  in 
this  chapter  regarding  the  quantities  and  qualities 
of  food  suitable  for  the  average  man  and  woman, 
especially  those  dwelling  in  towns,  are  the  following. 
The  average  townsman  requires  a  quantity  of  from 
three-quarters  of  a  pound  to  a  pound  and  a  half 
daily  of  mixed  food  as  it  comes  to  the  table.  The 
average  townswoman  requires  a  little  less.  About 
one  ounce  of  food  a  day  for  every  ten  pounds  of 
body  weight,  or,  perhaps,  in  the  case  of  growing 
children,  every  eight  pounds  of  body  weight,  seems 
to  be  enough  and  not  too  much.  According  to  this 
scale,  a  man  weighing  140  pounds  would  require 
about  14  ounces  of  mixed  food  daily,  and  a  man  of 
12  stones  rather  more  than  a  pound  avoirdupois. 
As  to  quality  we  require  a  mixed  diet  of  proteids, 
fats,  carbo-hydrates,  and  mineral  matters  ;  but 
whether  we  should  get  our  proteids  from  animals 
or  vegetables  may  reasonably  be  left  to  each 
person's  judgment  and  (perhaps)  conscience.  The 
moral  arguments  against  the  slaughter  of  somewhat 
noble  animals  for  food  have  always  seemed  to  me 
stronger   than  the  scientific   ones.     The  man   who 

U2 


324 

allows  himself  to  think  about  the  question  usually 
inclines  to  take  less  and  less  meat.     At  one  time, 
thinking  that  an  excess  of  starch  in  the  diet  was 
the  chief  cause  of  illness,   I  inclined  to  too  much 
diminution  of  the  starch,  and  was  therefore  driven 
to  the  use  of  meat  instead.     For  persons  suffering 
from  the  effects  of  over  ingestion  of   starch    and 
sugar,  the  Salisbury  diet  of  meat  and  hot  water  is 
no  doubt  often  very  useful ;  but  its  chief  use,  after 
all,  I  believe,  is  that  it  restricts  the  diet.     To  take 
four  ounces  of  beef  three  times  a  day  is  a  great 
reduction  of  food  from  taking  two  pounds  or  three 
pounds   avoirdupois   of   mixed  diet,   the  taking    of 
which  makes  so  many  of  us  ill.     But  when  we  see 
that    although    it    happens   to   have    been,    as    an 
accident,  starch  and  sugar  which  has  made  us  ill, 
the  real  and  essential  cause  has  been  too  much  food 
taken  too  often,  we  also  see  that  it  was  an  accident 
only,  and  that  the  reduction  of  our  mixed  diet  to 
four  or  five  ounces  taken  three  times  a  day,  with  or 
without    the    washing    out   by    hot    water,    would 
equally  have  enabled  us  to  recover.     It  is  easy,  in 
these  as  in  other  matters,  to  mistake  the  accident 
for  the  property,  to  mistake  too  much  starch  and 
sugar  for  too  much  food,  and,  therefore,  to  recom- 
mend  as   a   remedy   the   cessation    of    the    former 
instead  of  a  wise  and  cautious  restriction  of  the 
latter.     And,  indeed,  in  the  conflict  of  opinion  and 
practice,  there  is  some  excuse  for  going  wrong,  or  for 
failing  to  see  all  the  bearings  of  the  problem   at 
first.     A  man  who  should  take,  for  instance,  three 


325 

pounds  of  beef  daily,  as  some  persons  do,  would 
probably  soon  find  that  he  was  taking  too  much 
food.  As  to  calorie  value,  however,  even  three 
pounds  of  lean  beef  daily  is  only  equal  to  about 
2000  grand  calories,  or  perhaps  somewhat  less. 
According  to  Mrs.  Richards,  a  mere  subsistence 
ration  amounts  to  2000  calories.  On  the  other 
hand,  Forster  found  that  a  lawyer  at  Munich 
consumed  as  much  food  as  would  supply  2400 
calories,  and  a  physician  at  the  same  place  2830 
calories ;  while  Banke  found  that  a  university 
professor  at  the  same  place,  with  very  little 
exercise,  consumed  as  much  food  as  would  produce 
2325  calories.  These  figures  appear  to  me  to  go  in 
the  direction  of  corroborating  what  I  said  before  as 
to  the  relation  between  plain  living  and  high 
thinking,  as  also  the  physiological  facts  regarding 
the  circulation  in  the  brain  and  muscles  respectively. 
Then,  lastly,  as  to  times  of  eating,  we  conclude 
that  no  one  ought  to  eat  oftener  than  three  times 
daily,  say  at  8-0  a.m.,  and  1-0  and  7-0  p.m.  ;  that 
in  many,  if  not  in  most  cases,  it  is  better  to  eat 
twice  than  even  three  times,  say  at  12-0  noon  and 
7-0  p.m.,  or  at  9-0  a.m.  and  6-0  p.m.,  if  more 
convenient  (in  the  latter  case,  a  cup  of  hot  cocoa 
or  coffee  about  1-0,  with  no  solid  food,  would 
provide  a  good  physiological  stimulus)  ;  that  to  eat 
twice  a  day  is  suitable  even  for  growing  children, 
of  whom,  however,  more  will  be  said  in  a  subsequent 
chapter  ;  and,  lastly,  that  in  many  cases  it  is  better 
for  the  townsman  to  eat  once  a  day  only,  rather 


326 

than  thrice,  or  even  than  twice.  In  the  last  case, 
the  best  time  for  eating  is  about  mid-day,  or  say 
from  12-0  noon  to  1-30  or  2-0  p.m.  ;  and  a  cup  of 
tea  or  cofiee  may  fitly  be  taken  morning  and  evening 
besides,  without  any  accompaniments  ;  or,  instead  of 
the  evening  tea,  a  glass  of  milk  with  or  without  the 
addition  of  an  equal  quantity  of  hot  water  or  of 
barley  water.  The  total  quantity  of  fluids  required 
by  the  average  townsman  appears  to  be  from  two  to 
three  pints  daily.  We  get  rid  of  about  two  and  a 
half  pints  of  water  from  the  kidneys  daily,  and  about 
another  pint  of  water  from  the  skin  and  lungs,  but 
we  appear  to  manufacture  water  inside  the  economy 
by  combining  the  hydrogen  of  the  food  with  the 
oxygen  of  the  inspired  air  (water  =  HgO),  but  to 
what  extent  we  do  this  has  not  been  accurately 
determined. 


327 


CHAPTER    IX. 


On   Heredity   in   Disease. 


TT  appears  to  me  that  the  frequency  with  which 
disease  is  transmitted  is  greatly  exaggerated  in 
common  estimation  ;  that  is,  I  think  that  disease  is 
comparatively  seldom  transmitted,  while  it  seems, 
from  what  I  hear,  that  the  opinion  is  very  generally 
held  that  it  is  often  or  very  often  transmitted. 
True,  it  is  very  difficult  to  get  a  clear  idea  as  to 
what  doctrine  on  this  subject  is  generally  favoured 
by  the  medical  profession,  and  therefore  by  the 
public,  who,  on  the  whole,  take  their  opinions  on 
trust  from  them.  But  let  us  take  a  case  or  two 
from  medical  literature  to  shew  what  seems  to  be 
the  common  doctrine.  A  distinguished  medical 
writer  instances  as  a  proof  of  the  hereditary  trans- 
mission of  disease  the  following  case.  He  has  so 
little  doubt,  apparently,  on  the  point,  that  he 
assumes,  or  seems  to  assume,  that  the  mere 
statement  of  his  case  proves  his  theory  of  trans- 
mission. A  lady  of  45  years  of  age  appears  in  his 
consulting  room  suffering  from  psoriasis,  which  is  a 
dry,  scaly,  often  reddish  coloured  or  grey  and 
reddish  coloured  form  of  skin  affection.  He  is  a 
good  note  taker,  and  has  a  good  memory,   and  so 


328 

when,  twenty  or  so  years  after,  the  daughter  of 
that  lady,  now  at  the  same  age  as  her  mother  was 
twenty  years  before,  appears  in  the  same  consulting 
room,  suffering  from  an  affection  precisely  similar, 
he  is  greatly  struck,  and  turning  to  his  notes  and 
comparing  the  two  sets  of  skin  eruption,  finds  them 
to  be  identical,  or  almost  identical.  And,  as  I  have 
said,  the  mere  statement  that  the  same  or  a  similar 
skin  affection  has  appeared  in  mother  and  daughter 
at  similar  ages  seems  to  him  (as  to  most  other 
people  also,  if  one  may  judge  from  the  fact  that  no 
one  has  ventured  to  call  the  theory  in  question),  to 
justify  him  in  instancing  the  succession  of  cases  as 
a  clear  proof  of  the  hereditary  transmission  of 
disease.  But  is  it?  Where  is  the  proof?  Let  me 
put  my  view  of  the  case  before  we  go  further. 
I  do  not  question  the  facts,  which  is  a  great 
comfort,  since  the  issue  between  the  two  views  is 
thus  narrowed  and  limited,  and  much  verbal  dis- 
cussion and  disputation  is  avoided.  I  contend  that 
organisation  is  transmitted,  but  disease  not,  or  so 
rarely  that  we  may  as  a  practical  theory  or 
conclusion  throw  it  out  of  account.  Now  let  us 
look  at  the  question  for  a  little.  Suppose  that  a 
man,  and  his  father,  and  his  grandfather  have  been 
soldiers,  and  that  one  after  another  at  say  20  years' 
interval,  they  were  each  shot  in  action  ;  should  we 
expect  anyone  to  agree  with  us  in  the  suggestion 
that  death  by  gun-shot  wound  or  rifle  bullet  was 
hereditary  in  that  family  ?  And  if  the  son  of  our 
last  soldier  became  a  grocer,  are  not  the  probabilities 


329 

great  that  he  would  die  in  his  bed  ?  It  will  be 
said,  "  Oh,  that  is  quite  different.  Everyone  can  see 
th  at  it  was  the  circumstances  of  life,  the  occupation, 
the  calling,  the  environment,  which  caused  the 
three  successive  deaths  in  three  different  generations ; 
but,  in  the  cases  of  psoriasis  quoted,  there  is  no 
proof  that  this  was  so."  It  certainly  seems  very 
remarkable  at  the  first  blush  that  the  psoriasis 
should  appear  in  mother  and  daughter  at  the  same 
age.  I  will  now,  however,  state  my  theory  in  order 
that  it  may  be  seen  side  by  side  with  the  other,  and 
(I  suppose)  the  commoner  view.  Organisation  is 
transmitted ;  disease  not,  or  very  seldom.  Being 
translated,  this  means  that  :  like  causes  acting  on 
like  organisms  in  successive  generations  (or  in  the 
same  generation)  induce  like  effects.  Before  I 
admit  that  the  disease  psoriasis  was  transmitted, 
I  must  know  what  the  causes  of  psoriasis  are  (I 
know  what  the  cause  of  being  killed  in  battle,  is) 
and  then  I  must  know  (1)  whether  the  mother  was 
subjected  to  the  action  of  those  causes — whether, 
for  example  (for  I  think  this  is  the  chief  cause),  she 
took  too  many  meals,  too  much  bread,  cakes, 
sweets,  and  puddings,  but  generally  too  much  food ; 
and  (2)  whether  in  her  turn  the  daughter  did  the 
same.  If  they  did,  then  I  see  no  proof  of  the 
hereditary  transmission  of  the  disease,  but  I  do  see 
proof  of  my  theory  that  too  much  food  (essentially) 
too  much  bread,  cakes,  puddings,  and  sugar 
(accidentally)  was  the  cause  of  the  psoriasis  first 
in    the   mother   and   then   in   the    daughter.      The 


330 

burden  of  proof  of  the  hereditary  transmission  of 
disease  is  on  the  man  who  alleges  its  existence, 
not  on  him  who  objects  to  it.  But  I  do  not  care 
about  this.  I  am  quite  willing,  so  strong  is  my 
case,  to  assume  the  burden  of  proof  Take  the 
case  of  consumption  or  of  cancer.  Consumption 
has  been  reduced  in  the  British  Army  from  12  per 
1000  per  annum  to  1*2  per  1000  per  annum  since 
the  time  of  the  Crimean  war.  The  commission 
which  sat  upon  the  subject  found  that  consumption 
was  much  more  rife  in  the  line  regiments  who  had 
only  350  cubic  feet  of  space  allowed  per  man  in 
barracks  than  among  the  guards  who  had  500  cubic 
feet  of  space  per  man  allowed  ;  so  they  recom- 
mended that  the  line  regiments  should  be  allowed 
500  cubic  feet  of  space  per  man  also.  But  I  never 
heard  that  they  recommended  that  careful  enquiry 
should  be  made  into  the  family  history  of  recruits 
for  the  army,  and  that  those  recruits  should  be 
rejected  whose  families  gave  a  history  of  the 
presence  of  consumption.  No  doubt  they  insisted 
on  chest  measurements  being  taken,  but  that  was 
done  also  before  the  question  of  how  to  prevent 
consumption  in  the  army,  or  how  to  diminish  it 
was  discussed.  A  narrow  chest  is  a  condition 
of  organisation,  and  it  may  be  and  is  trans- 
mitted, but  whether  it  will  take  on  consumption 
is  a  question  of  environment.  It  is  quite  a 
question  whether  a  man  whose  chest  measures  say 
only  28  inches  in  circumference,  instead  of  34  or  36 
inches,  ought  to  be  admitted  into  the  army  at  all. 


331 

The  probabilites  are  that  he  will  take  on  con- 
sumption if  submitted  to  the  hardships  of  a 
campaign,  but  that  is  a  question  of  organisation 
and  resistance.  No  doubt  his  resistance  will  be 
lower  (other  things  being  equal)  than  that  of  the 
fuller  chested  man.  And  if  it  had  so  happened, 
as  very  likely  it  might,  that  consumption  was 
abundant  in  the  narrow  chested  man's  family,  one 
may  easily  get  a  false  impression  regarding  the 
transmission  of  disease,  and  may  think  that  disease 
is  transmitted,  when  in  reality  it  is  not  disease 
which  is  transmitted,  but  the  organisation,  which, 
having  a  low  resistance,  is  apt  to  take  it  on.  So 
with  cancer.  Many  families  shew  numerous  cases 
of  cancer  occurring  in  successive  generations. 
But  cancer  mainly  is  due  to  too  many  meals ; 
and  if  the  children  of  cancerous  parents,  eating 
four  or  five  meals  a  day,  would  confine  them- 
selves to  two  meals,  or,  in  rare  cases,  to  one  a 
day,  there  would  soon  be  much  less  cancer  to 
chronicle  than  there  is  now.  Organisation  is 
transmitted;  not  disease,  or  at  least  very  rarely. 
But  talking  of  cancer,  or  even  of  the  psoriasis  with 
which  we  started,  raises  another  consideration, 
which  appears  to  me  to  have  received  far  too  little 
examination.  Is  it  not  likely,  if  disease  is  trans- 
mitted, that  it  will  appear  early  in  life  ?  It  seems 
as  if  it  should.  If  children  inherit  disease  from 
their  parents,  should  not  inherited  disease  appear  in 
infancy  or  childhood,  since  the  nearer  that  children 
are  to  their  parents  the  more  prone  they  ought  to 


332 

be  to  suffer  from  their  parents'  diseases  ?  For  my 
part  I  cannot  get  away  from  this  conclusion  ;  and 
so  far  as  the  evidence  goes  why  should  I  wish  to  get 
away  from  it  ?  Is  not  a  clear  conception  of  the 
facts  the  first  thing  we  ought  to  aim  at?  and  a 
sound  theory  to  account  for  all  the  facts  the  next 
thing  ?  It  has,  in  fact,  often  seemed  to  me  that 
perhaps  the  great  mortality  in  the  first  year  of  life, 
and  even  in  the  first  five  years  of  life,  may  be 
partly  due  to  a  considerable  amount  of  inheritance 
of  disease.  However,  our  medical  ofiicers  of  health 
appear  to  think,  and  I  agree  with  them,  that  even 
here  the  chief  cause  of  mortality  is  wrong  feeding, 
and  not  inherited  disease.  Still,  inherited  disease 
may  be  a  part  of  the  cause  of  the  high  mortality  of 
early  life.  Or  we  may  put  it  :  perhaps  it  is  not 
even  inherited  disease  which  is  the  cause  of  the 
high  infant  mortality ;  it  may  be  simply  extra 
predisposition  to  it.  I  should  like  to  say  a  word 
here  about  predisposition  to  disease.  So  far  as  I 
can  see,  predisposition  is  neither  more  nor  less  than 
weakness,  or,  as  it  may  be  better  to  say,  it  is 
inverse  resistance.  Now  resistance  is  a  quality  of 
organic  or  organised  matter  (as  it  is,  of  course,  of 
inorganic  matter  also),  and  if  organisation  is 
inherited,  the  qualities  of  organisation  must  be 
inherited  also ;  and  therefore  predisposition  to 
disease,  that  is,  a  less  amount  of  resistance  than 
usual  to  the  causes,  which,  acting  on  the  organism, 
and  especially  on  the  young  organism,  disorder  it 
or  produce  disease  (it  is  better  to  say,    throw  the 


333 

organism  into  disease,  or  cause  the  organism  to 
become  diseased),  will  be  inherited  also.  It  is  well 
known  that  we  all  have  very  varying  amounts  of 
resistance,  not  only  to  causes  which  produce  disease, 
but  to  influences  outside  and  inside  us,  which 
produce  all  sorts  of  modifications  in  us.  From  this 
point  of  view  we  are  all  predisposed  to  every 
human  characteristic ;  but  we  are  not  equally 
predisposed  to  each  characteristic.  To  confine  our 
consideration  to  the  matter  under  discussion,  we  are 
all  predisposed  to  the  fevers,  to  inflammations,  to 
rheumatism,  gout,  tubercle,  cancer,  and  all  other 
human  diseases.  Indeed,  we  may  go  further  and 
say,  we  are  predisposed  not  only  to  all  these  human 
diseases,  but  to  the  diseases  of  animal  organisation 
in  general ;  since  the  lower  animals  also  suffer  from 
all  these  diseases.  So  that,  from  our  inheriting 
that  general  form  of  organisation  which  we  share 
with  animals  (and  even  with  plants),  we  inherit 
predisposition  to  all  the  disorders  to  which  organ- 
isation is  subject  ;  while  from  inheriting  the  special 
form  of  organisation  we  caU  human,  we  are  liable 
to  every  human  disease  and  ailment.  We  are 
liable  to  all  human  ailments,  but  (except  in  a  very 
few  instances — I  do  not  deny  inheritance  of 
disease — I  have  seen  it,  but  it  is  very  rare),  it 
depends  on  how  we  manage  ourselves,  and  in  help- 
less early  life  it  depends  on  how  our  parents  or 
guardians  manage  us,  whether  we  shall  be  subject 
to  diseases  or  not.  To  say  that  this,  that,  or  the 
other  disease  is  not  known  in  our  family,  or  that  a 


334 

given  disease  is  particularly  rife  in  our  family,  is 
only  to  say  that  the  influences  making  for  its 
production  were  not  or  were  great  among  the 
members  of  our  family  on  the  one  hand ;  or  on  the 
other,  that  our  family's  resistance  to  these 
influences  was  or  was  not  great,  or  was  or  was  not 
greater  than  that  of  other  families.  In  examina- 
tions for  life  insurance  many  companies  ask  a 
question  like  this  :  is  your  family  particularly 
prone  to  any  form  of  inherited  disease,  to 
rheumatism,  gout,  cancer,  or  tubercle,  or  other 
disease  known  (?)  to  be  hereditary  ?  And  the 
answer  is  generally  :  none  of  these  diseases  are 
known  in  my  family  ;  but  in  point  of  fact  all 
diseases  are  known  in  all  families,  but  in  some  more 
and  in  some  less.  It  is  not  only  in  mental  and 
moral  regions  that  one  may  say  Homo  sum  et  nihil 
humanum  alienum  a  me  puto ;  but  this  is  chiefly 
because  like  causes  acting  on  like  organisms  in 
succeeding  generations  induce  like  effects.  Predis- 
position is  therefore  inverse  resistance.  It  seems  a 
mere  play  upon  words  to  say  that  no  one  can  suffer 
from  any  disease  who  had  not  the  predisposition  to 
do  so ;  and  yet  a  great  writer  has  delivered  himself 
of  this  truism  as  regards  the  acquisition  of  physical 
characteristics.  If  the  resistance  of  the  organism 
to  the  poison  of  influenza  (or  to  any  other  influence) 
is  great,  then  predisposition  is  small  or  slight.  If, 
on  the  other  hand,  predisposition  is  strong,  then 
resistance  is  slight.  Predisposition  and  resistance 
seem  to  be  inversely  as  one  another,  the  greater  the 


335 

one  the  less  the  other,  and  the  less  the  one  the 
greater  the  other.  If  health  is  maintained  by- 
proper  management  in  respect  particularly  of 
proper  relations  between  the  body  and  air,  food  and 
exercises,  then  the  economy  will  be  able  to  oxidise 
off  and  to  resist  without  illness  a  much  larger 
amount  of  the  poison  of  influenza  than  if  the  air 
we  breathe  is  foul,  the  food  we  consume  is  unsuit- 
able, either  in  amount  or  quality,  and  the  exercises 
or  movements  we  perform  are  insufficient  or  not 
properly  methodised.  If  health  is  at  a  standard 
sufficiently  high  as  regards  these  conditions,  it 
seems  as  if  the  poison  of  influenza  would  or  might 
have  no  effect  on  us  at  all.  Of  course,  any  one 
who  has  been  compelled  by  reflection  and  evidence 
to  adopt  this  view  regarding  the  susceptibility  to 
influenza  or  other  infectious  diseases,  would  not 
hesitate,  if  he  were  himself  attacked,  to  admit  that 
he  felt  somewhat  humiliated,  since  he  would  feel 
that  he  had  not  been  able  to  live  up  to  his 
own  principles.  If,  on  the  other  hand,  he  were 
attacked  by  influenza  with  complications,  like 
pneumonia,  or  the  long  depressed  condition  which 
sometimes  follow  it,  ending  in  consumption  or 
organic  heart  disease,  he  might  even  feel  disgraced, 
since  he  would  know  that  in  both  of  these 
conditions  he  had  been  improperly  fed,  and, 
especially  in  the  case  of  influenza  occurring 
with  complications,  he  had  been  for  a  long  time 
previously  to  getting  it,  over-fed.  I  might  lik& 
to   stipulate   for   the   absence  of  very   severe  and 


336 

very  long  continued  anxiety  as  a  predisposing 
cause  in  this  case ;  but  the  amount  of  anxiety  to 
which  I  refer  would  have  to  be  very  great  indeed, 
such,  for  instance,  as  befel  Job  when  messengers 
announced  to  him  in  quick  succession  the  loss  of  his 
oxen,  and  asses,  and  the  servants  who  were  tending 
them,  his  camels  and  their  attendants,  nay  the 
destruction  even  of  his  dwelling-house  besides ;  or, 
as  has  occurred  more  than  once  in  modern  business 
life,  when  a  man  has  lost  goods,  and  credit,  and 
friends,  and  when  even  his  family  have  not  escaped 
from  sickness  and  death.  And  if,  when  a  man's 
health  suffered  from  these  causes  we  could  conceive 
it  possible  that  even  his  wife  should  turn  against 
him,  his  anxieties  would  be  so  great  as  probably  to 
make  him  ill,  however  properly  he  had  managed  his 
air,  food,  and  exercises.  But  such  combinations  of 
misfortune  are  rare  indeed,  and  are  comparable 
rather  with  the  effect  of  volcanic  eruptions,  or 
earthquakes,  or  tidal  waves,  which,  though  they  do 
occur  sometimes  in  the  physical  history  of  our 
earth,  are  so  rare  as  to  account  for  only  a  small 
part  of  the  evils  from  which,  on  the  whole,  we 
suffer.  By  establishing  proper  relations  between 
the  body  and  air,  food,  and  exercises,  but  par- 
ticularly between  the  body  and  food,  we  may  get,  it 
seems  to  me,  into  such  a  condition  as  not  to  fear 
the  pestilence  that  stalketh  in  darkess,  nor  the 
destruction  that  wasteth  at  noon-day.  Neither  we 
nor  our  households  need  have  any  terror  or  fear  of 
them.       And    the     state    of    freedom    from     the 


337 

apprehension  of  infection  to  which  one  person  or  one 
household  may  attain,  may  be  attained  by  all.  It 
is  not  necessarily  the  strongest  persons,  but  often 
the  most  delicate ;  it  is  not  those  whose  original 
predisposition  or  inverse  resistance  or  weakness  is 
least,  but  often  it  is  rather  those  whose  predis- 
position and  weakness  is  greatest  who  seem  most 
easily  influenced  by  the  kind  of  arguments  here 
advanced  to  aim  at  the  practices  of  self-restraint 
and  self-government  here  suggested,  with  the 
freedom  from  care,  and  anxiety,  and  disease,  which 
these  practices  bring  in  their  train.  I  do  no  more 
here  than  make  the  barest  reference  to  the  moral 
implicates  of  these  suggestions,  or  the  bearings 
they  have  on  life  in  all  its  manifold  aspects.  These 
may  perhaps  be  elaborated  and  amplified  by  others 
more  competent  to  deal  with  them.  I  confine 
myself  to  pointing  out  the  bearing  they  have,  if 
correct,  on  the  avoidance  of  suffering,  on  the 
number  of  early  deaths  their  carrying  out  might 
prevent,  on  the  diminution  of  the  number  of 
widows,  widowers,  and  orphans  they  might  effect, 
and  on  the  clearing  from  our  minds  of  those  unjust 
aspersions,  and  of  the  cant  and  self-complacency 
which  blames  our  ancestors  or  our  fate  for  evils 
which,  to  a  great  extent,  we  inflict  on  ourselves. 

Intimately  connected  with  the  term  predisposi- 
tion are  three  other  terms  frequently  used  by 
medical  writers  and  speakers,  viz.,  constitution, 
diathesis,  and  heredity  or  atavism.  To  these 
we    ought    to    devote    a    little    consideration.      I 


338 

propose  to  use  these  words  in  senses  perhaps  a  little 
different  from  those  in  which  they  are  commonly 
used — as  commonly  used,  they  are  often  convertible 
or  synonymous  with  one  another — but  I  do  so 
because  it  is  well  to  limit  the  sense  in  which  words 
are  used  so  as  to  attain  clearness  of  ideas  regarding 
them,  and  also  because  in  the  present  case  there  are 
three  natural  divisions  of  life  to  which  the  three 
words  in  question  can  be  easily  confined,  so  that 
this  desirable  clearness  can  be  attained.  By  con- 
stitution,  then,  I  mean  to  denote  the  state  of  the 
human  organism  from  the  moment  of  birth  to 
death.  Constitution,  from  this  standpoint,  being 
the  resultant  at  any  and  every  moment  of  the 
interaction  between  the  organism  or  economy  and 
its  environment,  that  is  (mainly)  between  the 
economy  and  its  air,  food  and  exercises ;  it  follows 
that  the  constitution  can  be,  and  is,  slowly  changed 
as  the  relations  of  the  organism  to  these  three 
things  (mainly)  or  generally  as  its  relations  to  its 
environment  alter  and  change.  The  environment  is 
the  sum  of  the  circumstances  affecting  the  organism 
from  birth  till  the  moment  under  consideration.  A 
complete  account  of  the  environment  would  be  a  com- 
plete history  of  the  relations  between  the  organism 
and  its  surroundings  from  birth  till  the  moment 
under  consideration ;  but  while  it  is  evident  that  an 
account  or  history  so  complete  as  that  is  unattain- 
able, the  general  effect  of  the  surroundings  upon  an 
organism  can  be  observed  well  enough,  and  the 
influence  of  the  more  important  of  them  can  also  be 


339 

observed.  But  constitution,  it  is  evident  from  these 
considerations,  must  be  always  flowing,  mobile, 
changing,  as  the  circumstances  of  the  environment 
change,  flow  and  alter.  Every  action  or  experience 
in  the  body  must  have  its  influence  on  the  constitu- 
tion, which  is  incessantly  changing ;  and,  as  any 
given  body  is  capable  only  of  a  certain  number  of 
changes  before  it  ends  or  dies,  each  action  must 
have  its  effect  in  hastening  that  termination.  But 
it  is  not  possible  to  estimate  the  effect  of  one 
action,  and  still  less  to  measure  it  with  any 
approximation  to  accuracy.  All  we  know  is  that  its 
influence  must  be  incorporated  in  the  constitution. 
But  the  effects  of  long-continued  mal-assimilation 
are  plain  enough,  not  only  theoretically  but  practic- 
ally, and  their  influence  in  hastening  the  termination 
of  life  is  often  quite  clear.  Ailments,  small  and 
great,  make  their  appearance,  as  we  have  seen,  and 
very  few  constitutions  come  to  an  end  from  simple 
old  age. 

I  think  perhaps  I  ought  to  draw  attention 
here  to  the  influence  we  may  exert  in  modify- 
ing or  altering  our  environment.  It  seems  to 
me  as  if  not  enough  attention  was  generally 
given  to  this  point.  We  seem  to  assume  too 
readily  that  environment  is  a  set  of  conditions  out- 
side of  our  power  and  influence,  as  if  environment 
influenced  us  rather  than  we  it.  But  both  are  true. 
Environment  acts  and  reacts  on  us,  no  doubt ;  but 
we  in  turn  act  and  react  on  it.  If  it  is  true,  within 
certain  limits,  that  environment  makes  us,  it  is  also 

V2 


340 

true  that  we  may  make  and  that  we  do  make  our 
environment.  In  the  moral  sphere  it  depends 
greatly  what  use  we  turn  our  trials  to,  what  effect 
they  have  upon  us ;  but  I  do  not  speak  of  that.  It 
is  true  also  in  the  lower  physical  plane  ;  and  by  the 
proper  and  moderate  use  of  the  great  natural 
environing  factors  of  air,  food  and  exercises,  the 
quantities  and  relations  of  which  are  very  greatly 
in  our  own  power,  we  can  modify  for  good,  and  the 
building  up  of  a  healthy  resistance  to  all  forms  of 
disease,  the  organism  which  we  inherit  and  possess. 
Heredity  or  atavism  is  the  state  of  the  organism 
as  determined  by  the  ancestors.  Whatever  this 
may  be  (and  a  very  complicated  subject  and  com- 
plicated condition  it  evidently  is),  it  is  plain  that, 
unlike  constitution,  which  is  always  changing, 
heredity  is  fixed  and  determined.  Our  ancestors 
have  come  and  gone.  They  have  lived  their  lives, 
and  transmitted  their  organisation,  with  its  qualities, 
whatever  they  are.  Our  heredity  or  atavism, 
transmitted  by  them  (mingled  with  the  diathesis 
immediately  to  be  defined),  and  from  them  received 
by  us,  is  fixed  and  determined.  What  it  was  and 
is,  that  it  remains.  Nothing  can  alter  it.  The 
heredity  of  a  human  being  determines  humanity. 
That  of  an  ox  bovinity.  That  of  a  fox  vulpinity. 
That  of  a  dog  caninity,  &c.  A  human  being,  an 
ox,  a  dog,  or  a  fox,  however,  will  live  healthily  or 
otherwise,  rather  in  accordance  with  the  circum- 
stances of  their  respective  environments  than  in 
regard  of  the  state  of  their  ancestors  ;    rather  in 


341 

regard  of  their  own  changing  constitution  than  of 
their  heredity.  But,  while  the  heredity  in  general 
of  human  beings  determines  humanity,  the  heredity 
in  special  of  a  particular  human  being  determines 
the  special  hereditary  characteristics  of  that  human 
being.  As,  however,  these  hereditary  character- 
istics, or  characteristics  received  through  inheritance, 
are  determined  by  ancestors  who  have  come  and 
gone,  it  is  evident  that  their  influence,  whatever  it 
is,  is  fixed  and  determined,  and  cannot  be  altered. 
Such  characteristics  as  size,  colour  of  hair  and  eyes, 
and  even  gait  and  handwriting,  dependent  on  shape 
and  form  of  hands  and  of  the  nervous  mechanism 
through  which  it  is  governed,  are  all  hereditary 
characteristics,  and  maintain  themselves,  as  we  see, 
from  generation  to  generation.  And  the  evolution 
of  the  changing,  mobile,  fluctuating  constitution 
through  the  fixed  and  now  changeless  heredity  is 
like  the  moral  relations  of  life,  which  may  be 
described  as  the  play  of  the  temporal  on  the 
eternal,  as  the  movement  of  that  which  is  for  a  day 
on  that  which  is  for  ever,  an  analogy  which  I  do 
not  elaborate  any  further. 

Lastly,  there  is  a  third  condition  or  period  of 
history  in  the  life  of  the  organism,  namely,  its 
intra-uterine  history.  To  this  it  is  proposed  to 
confine  the  term  or  name,  diathesis.  It  is  evident, 
if  this  definition  or  limitation  be  accepted,  that 
diathesis  is  a  state  intermediate  between  heredity 
on  the  one  hand  and  constitution  on  the  other  ;  and 
further,    that    diathesis,    like    heredity,  but    unlike 


342 

constitution,  is  fixed  and  determined.  If  it  be 
objected  that  the  proposal  to  limit  these  three 
commonly  used  words  to  these  particular  senses  is 
somewhat  arbitary,  the  reply  must  be  :  there  are 
three  great  natural  periods  in  the  history  of  organic 
beings,  and  these  three  words  seem  naturally  to  fit, 
or  can  be  made  to  fit,  or  suit,  each  word  one  of  the 
natural  periods.  And  whoever  is  unwilling  to  accept 
these  definitions  ought  to  be  prepared  with  the 
suggestion  of  better  ones. 

With  these  ideas  in  our  minds,  it  may  be  well 
to  try  to  see  further  into  what  is  transmitted  or 
inherited.  A  very  ancient  writer  delivered  himself 
of  the  following  views.  "  If,  then,"  he  says,  "  bald 
persons  arise  from  bald  persons,  and  blue-eyed 
persons  from  blue-eyed  persons,  and  squint-eyed 
persons  from  squint-eyed  persons  as  a  rule,  and 
as  the  same  rule  holds  good  as  regards  other  forms, 
why  may  not  long-headed  persons  be  produced 
from  long-headed  ones  ?  "  And  again,  speaking  of 
epilepsy,  which  the  priests  had  called  the  sacred 
disease,  contending  that  if  they  cured  it  they 
must  be  considered  the  representatives  on  earth  of 
divine  power,  while  if  they  did  not  cure  it,  who 
could,  they  said,  wonder  that  they  failed  since  it 
was  a  sacred  disease  ?  contending  against  and 
opposmg  this  doctrine,  he  says  :  "  For  if  from 
phlegmy  persons  phlegmy  arise,  and  from  bilious 
persons  bilious  are  generated,  and  from  phthisical 
persons  phthisical,  and  from  spleeny  persons 
spleeny  "  (those  who  sufier  from  affections  of   the 


343 

spleen,  a  blood-making  gland),  "  why  may  not  those 
parents  who  suffer  from  epilepsy  transmit  it  like- 
wise to  their  descendants  ? "  These  passages 
are  very  interesting,  as  shewing  the  ancient  view 
of  the  heredity  of  disease.  It  appears  to  me 
that  they  mix  up  in  the  most  delightful  and 
the  most  unconscious  and  confusing  way  the 
transmission  of  organisation  and  the  transmission  of 
disease.  We  should  admit  to-day  that  blue-eyed 
persons  have  as  a  rule  blue-eyed  children,  and 
(physically)  long-headed  persons  long-headed  chil- 
dren. We  might  or  might  not  admit  that  bald 
persons  have  bald  children.  In  fact  most  children 
are  born  with  hair,  which  they  soon  lose  as  a  rule, 
becoming  quite  bald  ;  after  which  the  hair  grows 
again,  fair  in  the  case  of  those  descended  from 
fair-haired  ancestors,  and  dark  in  the  case  of  those 
descended  from  dark-haired  ancestors.  And  we 
might  or  might  not  admit  that  squints  were 
transmitted ;  while  we  should  probably  think  that, 
not  epilepsy,  but  the  unstable  organisation  of 
nervous  system,  which  easily  takes  it  on,  was 
transmitted — at  least  this  would  be  my  view.  But 
we  should  all  (I  suppose)  deny  that  phlegms  or 
catarrhs  were  generally  transmitted,  that  bilious- 
ness comes  down  from  ancestors,  that  consumption 
is  transmitted,  and  affections  of  the  spleen.  At 
least  I  do  not  know,  but  I  suppose  we  should.  It  is 
very  difficult  to  get  at  the  mind  of  the  medical 
profession  on  this  subject,  if,  indeed,  it  has  made  up 
its  mind.     Some  time  ago  I  was  treating  as  more  or 


344 

less  ridiculous  the  idea  that  special  susceptibility  to 
take  fevers  ran  in  families,  or  contending  at  any 
rate  that  only  resistance  as  a  quality  of  organisation 
was  transmitted ;  when  a  distinguished  physician 
wrote  to  say  he  did  not  at  all  agree  with  me,  and 
that  he  felt  convinced  that  some  families  shewed 
much  more  predisposition  to  take  fevers  than  did 
others.  If  this  means  anything  more  than  that 
resistance  is  greater  or  less  in  different  persons,  and 
in  different  families,  to  the  causes  which  induce 
fevers,  I  confess  I  do  not  know  what  it  does  mean  ; 
but  in  that  sense  I  quite  agree  with  him.  As, 
however,  he  combated  my  view,  I  suppose  he  must 
have  meant  something  more.  What  I  meant  then, 
however,  and  mean  now,  is  this.  I  must  admit,  of 
course,  that  varying  degrees  of  resistance  to  the 
causes  which  induce  epidemic  and  other  disease,  are 
transmitted.  This  is  a  commonplace  of  observation, 
and  is  only  to  say,  what  everyone  knows,  that 
infants  come  into  the  world  with  varying  degrees  of 
strength.  But,  every  minute  that  life  lasts,  we 
begin  to  alter  our  original  strength  or  weakness,  or 
our  predispostion,  by  the  ways  in  which  we  live,  or 
in  which  our  parents  or  guardians  make  us  live  ;  by 
the  care  or  carelessness,  or  the  wisdom  or  folly  with 
which  they  treat  us.  And  so  it  comes  about  that 
in  a  comparatively  short  time  we  alter,  or  have 
altered  for  us,  and  that  to  a  very  considerable 
extent,  the  predisposition  to  disease,  or  otherwise 
the  weakness  of  resistance  against  it  with  which 
we  started  life.     And  obviously  this   is   more    and 


345 

more  our  own  doing  as  we  go  on  in  life  to  form  our 
own  habits,  and  to  gradually  go  on  into  delicacy  or 
strength  of  constitution,  and  manifest  (what  we 
really  therefore  make  for  ourselves),  more  or  less 
readiness  to  be  attacked  by  epidemic  or  other 
disease.  This  is  only  an  illustration  of  what  was 
said  before,  that  constitution  is  always  flowing, 
mobile,  changing,  coincidently  with  changes  in  the 
circumstances  or  environment  to  which  we  are 
subjected,  or  to  which  we  subject  ourselves. 

A  phrase,  by  the  way,  which  our  ancient 
authority  makes  use  of,  and  that  twice,  once  in 
each  of  the  passages  which  I  have  translated  from 
him — o  yap  y6vo<5  iravToxoOev  ep-yerai — reminds  us 
very  much,  or  rather  may  be  said  to  anticipate,  in 
a  somewhat  remarkable  manner,  Charles  Darwin's 
theory  of  pan-genesis,  especially  as  in  his  second 
statement  he  adds  the  words  rov  crcofxaTo?  ;  and  we 
seem  to  see  the  organic  body  throwing  off  its 
gemmules  from  all  parts. 

Discussion  of  such  a  subject  as  this  might 
easily  fill  a  treatise ;  so  I  will  only  go  on  to  say 
briefly  one  or  two  words  more  about  it.  The  view 
I  am  advocating  seems  to  me  on  the  whole  to  take 
more  and  more  of  the  influences  that  determine  the 
course  of  life  out  of  the  hands,  so  to  say,  of  fate  or 
necessity,  and  to  shew  more  and  more  how  much 
we  have  in  our  own  power.  I  did  not  adopt  it 
because  of  this  feature  at  all ;  but  having  come  to 
it  for  other  reasons,  I  found  that  it  did  lend  support 
to  the  more  hopeful  view.     I  once  saw  the  liver  of 


346 

a  child  of  eight  years  of  age,  which  shewed  all  the 
features  of  gin  drinkers'  liver,  of  what  is  known  as 
the  hob-nail  liver,  although  the  child  had  never 
tasted  gin  at  all ;  but  his  father  was  a  drunkard. 
An  appalling  fact  of  this  kind  fills  the  mind  with 
awe,  as  we  seem  to  see  the  sins  of  the  father 
visited  on  the  child ;  and  it  is  facts  of  this  kind 
which  prevent  one  from  denying  that  disease  is 
sometimes  transmitted.  But  how  rare  this  is  after 
all.  In  thirty  years  no  other  case  like  it  has  come 
under  my  observation.  No  doubt  at  all,  if  one's 
eyes  had  been  opened,  more  such  cases  might  have 
been  observed ;  but  even  then  I  believe  they  would 
have  been  few,  and  certainly  the  evidence  does  not 
warrant  any  other  conclusion  than  this,  that  the 
vast  majority  of  the  children  of  diseased  parents, 
even  of  drunkards,  are  born  healthy.  This  view  is 
in  keeping  with  the  latest  expert  opinion  on  the 
subject,  that  acquired  characteristics  are  not 
transmitted,  that  is,  that  they  are  not  often  trans- 
mitted, although  it  is  equally  plain  that  they  are 
transmitted  sometimes ;  indeed,  if  they  were  not,  I 
do  not  see  how  evolution  could  be  possible.  But 
that  it  is  not  the  rule  that  they  are  transmitted, 
but  quite  the  contrary,  is  shewn  not  only  by  direct 
observation,  as  we  have  seen,  but  also  from  this 
theoretical  reflection  that,  if  they  were,  the  race 
must  long  before  now  have  been  swept  away  from 
off  the  face  of  the  earth,  since  not  only  we,  but  all 
our  fathers,  have  broken,  and  that  not  once,  but 
repeatedly,  the  laws  of  life  and  health. 


347 

It  may  be  said  that  it  is  not  always  possible  to 
distinguish  between  the  organisation  which,  I  say, 
is,  as  a  rule,  transmitted,  and  the  disease,  which,  I 
contend,  is  not  or  not  often.  This  is  true,  no  doubt. 
Organisation  and  disease  shade  off  into  one  another 
by  a  large  variety  of  gradations,  so  subtle  that  it 
is  very  difficult,  if  not  impossible,  to  say  where 
organisation  leaves  off  and  disease  begins.  A 
defective  structure  of  the  heart  valves,  for  instance, 
would  be  an  example  of  imperfect  organisation,  and 
might  be  transmitted.  If  it  were,  the  moment 
that  such  valves  began  to  act,  it  might  be  quite 
impossible  to  distinguish  between  the  defective 
organisation  which  caused  imperfect  circulation  of 
the  blood,  and  the  nutritional  signs  of  that 
imperfect  circulation.  But  this  is  a  kind  of 
difficulty  which,  as  we  before  saw,  is  continually 
being  m.et  with  in  our  study  of  nature ;  and  we 
have  seen  instances  of  it  before  in  the  attempt  to 
separate  day  from  night,  heat  from  cold,  and,  in 
fact,  all  contraries  from  one  another.  The  poet, 
indeed,  revels  in  the  illustration  of  such  subtle 
gradations,  and  much  poetry  and  a  good  deal  of 
philosophy  turns  on  it.  The  idea  is  well  illustrated 
in  such  a  quotation  as  that 

"  Day  in  a  breathless  passion  kissed  dark  Night, 
And  neither  spoke.     And  in  that  kiss  Day  died." 

The  idea  would  have  been  equally  well  expressed 
if  night  had  been  made  to  kiss  the  day,  or  the  hot 
the  cold,  or  the  dry  the  moist,  or  any  other  opposite 
its   contrary ;    and   yet   this   does  not   prevent   us 


348 

from  being  able  to  make  practically  workable 
demarcations  of  day  from  night,  of  hot  from  cold,  of 
dry  from  moist,  nor  of  organisation  and  its  healthy 
functioning  from  diseased  functioning.  A  good 
idea  of  what  is  transmitted  and  what  is  not,  might, 
it  has  frequently  seemed  to  me,  be  obtained  from 
the  attempt  to  answer  the  question  :  how  is  it  that 
every  baby  born  into  the  world  comes  in  with  the 
soles  of  its  feet  a  great  deal  thicker  than  the  tops 
or  dorsa  of  its  feet,  and  yet  is  born  without  corns  ? 
If  a  long  succession  of  walking  ancestors,  each 
using  in  paws  and  feet  the  under  parts  of  the  feet 
to  walk  on — if  this  long  succession  of  walking 
ancestors  determined  the  former,  why  not  the 
latter  also  ?  And  the  only  answer  that  occurs  to 
me  is  that  it  seems  to  be  because  the  long  line  of 
walking  ancestors,  whose  habits  brought  about  the 
former,  was  a  much  longer  procession  than  of  the 
ancestors  whose  feet  were  pressed  in  tight  boots  and 
shoes.  But  if  this  is  the  correct  answer,  then  it  is 
evident  that  characteristics  acquired  in  an  indefinite 
number  of  previous  generations  must  in  course  of 
long  ages  be  transmitted  ;  but  in  what  generation 
the  characteristic  in  question  began  to  be  trans- 
mitted, it  is  exceedingly  difficult  and  even  impossible 
to  say. 

Another  question  arising  out  of  the  views 
advanced  here  is  this.  We  can  see  it  arising  in  the 
cases  of  psoriasis  with  which  we  started,  and  in  the 
attempt  to  answer  the  question  whether  cancer  is 
transmitted.     If  the  mother  and  daughter  who  had 


the  psoriasis  were  each  of  them  45  years  of  age 
before  they  shewed  the  psoriasis,  and  if  the  mother 
was  25  years  oP  age  when  her  daughter  was  born, 
is  it  hkely  that  the  mother  transmitted  to  the 
daughter  a  disease  which  she  did  not  herself  have 
till  20  years  after  her  daughter  was  born  ?  This 
does  not  appear  to  me  likely,  I  must  say.  Or  take 
the  case  of  a  mother  and  a  daughter,  both  having 
cancer  say  at  55  years  of  age.  A  precisely  similar 
question  arises.  If  the  mother  was  25  at  her 
daughter's  birth,  is  it  likely  that  she  should  have 
transmitted  to  the  daughter  a  disease  which  she  did 
not  herself  manifest  until  30  years  after  her 
daughter's  birth  ?  This  does  not  seem  likely.  But 
if,  on  the  other  hand,  we  can  shew  that  improper 
feeding,  or  any  other  breach  of  the  laws  of  healthy 
life,  caused  the  psoriasis  or  the  cancer  in  the  mother, 
and  that,  in  the  course  of  20  or  30  years,  similar 
improper  methods  of  feeding  (or  any  other  causes) 
caused  psoriasis  or  cancer  in  the  daughter,  then  we 
have  efficient  causes  to  account  for  the  facts  without 
having  recourse  to  the  suggestion  of  hereditary 
transmission  to  account  for  it.  We  have  to  answer 
the  question :  whether  is  it  more  likely  that 
something  done  or  left  undone  by  the  mothers  20  or 
30  years  or  more  before  the  daughters  were  born 
is  the  cause  of  the  psoriasis  or  of  the  cancer,  or 
whether  is  it  more  likely  that  something  caused 
these  diseases  which  the  daughters  themselves  did 
between  their  birth  and  the  45  or  55  years  which 
elapsed  before  the  psoriasis  or  the  cancer  shewed 


350 

itself?  As  a  question  of  probability,  surely  no  one 
would  deny  that  the  latter  is  far  more  likely,  as  it 
also  seems  to  me  to  be  that  If  the  diseases  were 
really  transmitted  they  would  probably  have 
appeared  in  early  childhood,  when  the  influences 
of  the  parents  on  their  children  must  have  been 
much  stronger  than  we  can  suppose  them  to  have 
been  at  a  later  date.  This  is  not  a  mere  academic 
question.  It  has  the  most  important  practical 
bearings.  We  are  continually  being  pressed  with 
questions  and  suggestions  of  this  sort.  Children 
whose  parents  are  suffering  or  who  have  died  of 
what  is  believed  to  be  hereditary  disease,  come  from 
time  to  time  to  their  medical  adviser  to  ask  his 
opinion  on  this  question  :  Am  I  likely  or  certain  to 
suffer  as  my  mother  or  my  father  has  suffered  ?  Or 
they  are  more  or  less  depressed  by  the  suggestion 
that  they  are  more  or  less  certain  to  suffer.  If  the 
medical  adviser  can  conscientiously  reassure  them 
on  such  an  important  issue,  much  will  be  gained. 
If  he  can  say  :  You  have  your  mother's  organisa- 
tion, no  doubt,  but  it  depends  on  how  you  manage 
that  organisation  whether  you  in  turn  suffer  from 
her  disease  ;  the  affair  is  in  your  own  hands ;  avoid 
the  causes  which  made  her  ill,  and  you  need  not 
suffer — if  the  medical  adviser  can  say  this,  as  it 
seems  to  me  he  can,  what  a  load  is  taken  off  the 
daughter's  mind  or  the  son's  mind ;  and  what  a  load 
is  also  taken  off  the  mind  of  the  medical  adviser. 
The  mere  removal  of  the  apprehension  may  be,  and 
I  believe  often  is,  a  contributory  cause  in  preventing 


351 

the  onset  of  the  disease  which  the  child  fears ;  and 
although  I  did  not  adopt  my  view  of  heredity  in 
disease  in  order  to  be  a  suggester  of  hope  rather 
than  a  prophet  of  evil,  I  feel  very  glad  indeed  that 
the  opinion  to  which  I  have  come  from  the  evidence 
(as  I  think  and  believe)  carries  with  it  this  sugges- 
tion of  hopefulness,  as  it  carries  with  it  the  advice 
that  if  we  avoid  the  causes  of  our  ancestors' 
diseases,  we  shall  most  probably  not  suffer  from 
them.  Of  course,  we  must  wear  out  and  we  must 
die  of  something,  but  we  ought  to  die  worn  out, 
and  of  old  age,  not  of  disease.  And,  at  least,  it 
makes  the  most  tremendous  difference  to  our 
families  whether  we  die,  say  at  55,  or  live  to  70, 
since  in  the  latter  case  we  have  the  opportunity 
allowed  us  to  help  them  in  their  entrance  upon  life, 
and  in  the  former  we  disappear  just  about  the 
time  when  our  presence  and  influence  would  be  of 
most  use. 


352 


CHAPTER   X. 


On  the   Feeding   of   Children. 


TT7HE  inquiry  into  the  heredity  of  disease, 
resulting,  as  it  has  done,  in  the  general 
conclusions  that  it  is  organisation  which  is  inherited 
rather  than  disease,  and  that  the  general  law  of 
heredity  is  that  like  causes  acting  on  like  organisms 
in  succeeding  generations  induce  like  effects — that 
inquiry  seems  naturally  to  lead  up  to  some  obser- 
vations on  the  feeding  and  management  of  children. 
These  observations  need  not  be  numerous,  because 
the  principles  which  apply  to  the  feeding  of  adults 
apply  also  to  children,  and  may  be  summed  up  in 
the  one  word  moderation.  Too  frequent  and  too 
abundant  feeding  unfortunately  obtains  in  the  case 
of  children  as  well  as  in  the  case  of  grown  persons. 
Before  I  deal  with  this,  however,  and  with  what 
the  reader  has  probably  mentally  observed  to 
herself — how  can  the  principles  be  the  same  when 
the  child  is  growing,  while  the  adult  is  fully 
grown  ? — I  should  like  to  say  just  a  word  or  two  on 
another  point.  I  have  several  times  said  that  I 
thought  that  anxiety  must  be  reckoned  among  the 
predisposing  causes  of  illness.  Well,  in  the  case  of 
children,  this  cause  is  almost  entirely  absent.      If 


353 

children  are  destitute  (in  a  sense  all  children  are 
destitute,  being  paupers,  as  it  were,  and  dependent 
on  the  love  and  charity  either  of  their  own 
parents  or  relatives,  or  on  that  of  strangers),  they 
are  taken  charge  of  almost  always  by  some  one,  and 
seem  to  accept  the  inevitable  in  their  lot  in  the 
most  matter  of  fact  way,  without  murmuring,  or 
repining,  and  with  little  of  that  anxiety  which  is 
one  of  the  causes  of  illness,  and  of  the  aggravation 
of  illness  among  grown  people.  This  cause  being, 
therefore,  almost  wholly  eliminated,  the  problem  of 
managing  children's  ailments,  and  of  maintaining 
them  in  health,  is  by  so  much  more  easy  and 
hopeful.  But  in  them,  as  among  adults,  one  of  the 
chief,  if  not  the  chief  cause  of  illness  is  also  errors 
of  diet.  And,  more  than  this,  I  believe  that  the 
chief  cause  (after  making  what  allowance  is 
necessary  for  hereditary  disease — a  larger  amount 
probably  than  obtains  in  the  case  of  adults),  of 
disease  among  children  is  not  only  errors  of  diet, 
but  that  the  particular  form  which  those  errors  of 
diet  take  is  too  frequent  and  too  abundant  feeding. 
From  the  cradle  to  the  grave  this  cause  seems  to 
aflSiict  us.  Even  the  poor  suffer  from  it,  for  what  is 
commoner  among  all  classes  of  the  population  than 
to  feed  infants  too  frequently,  every  two  hours  for 
example,  or  every  time  they  cry ;  and  how  common 
are  digestive  ailments  in  consequence  of  this,  as 
shewn  by  the  presence  of  flatulence,  colicky  pain, 
constipation  or  diarrhaea ;  or  the  occurrence  of 
some  of  the  continued  fevers ;  or  of  bronchitis  or 
w 


356 

months,  6  ounces ;  at  twelve  months,  9  ounces  ;  and 
at  eighteen  months,  12  ounces  ;  but  in  early  life  the 
digestion  effected  in  the  stomach  is  almost  nil,  the 
stomach  acting  much   more  as  a  reservoir  than   a 
digestive  organ,  and  passing  its   contents   rapidly 
through  into  the  intestine,  where  practically  all  the 
digestion  has  to  be  effected.     The  number  of  feeds 
necessary  for  infants  varies  very  much  according  to 
the  different  views  of  the  different  experts,  and  it  is 
very  interesting  to  compare  different  practices  with 
one   another.     In   ancient  times  it  seems  to   have 
been  the  practice  to  feed  much  seldomer  than  now. 
For  instance,  Oribasius  (B.C.  403 — 326)  says  :  ^'Puer 
nuper  in  lucem  editus,  melle  primuni  nutriatur^'  (is 
this  the  source  or  authority  for  the  custom  followed 
yet  by  so  many  old  women  of  thrusting  a  piece  of 
butter  and  sugar  into  the  mouth  of  the  newly  born 
child?)  ''deinde  lacte  bis  in  die  vel  ad  summum  terT 
Milk  twice  a  day  or  three  times  at  the  outside,  that 
was    Oribasius's    prescription    for    the    feeding   of 
infants.     And  Paulus   Aegineta,  about  1000   years 
afterwards     (Circa     625    A.D.),    almost    slavishly 
follows    him,    for    he    says :  "  Primuni    alimentum 
recenter  nato  infanti  mel  exhibere  oportet ;  postea 
vero  lac  praebere  bis  in  die  aut  ad   summum    ter. 
.  .  .  Sufficit  autem  biennium  lacte  nutrire ;  deinde 
ad  cibos   transgredi.'"      The  infant  was  to  be  fed 
with  milk  twice  a  day  or  thrice  at  the  outside,  and 
the  milk  was  to  be  continued  for  two  years,  at  the 
end  of  which  time  a  change   was  to   be   made  to 
other  foods.     How  different  and  how  much  better  a 


357 

plan  was  this  than  the  modern  habit  of  feeding 
babies  every  hour  and  a  half  or  every  two  hours,  or 
than  that  which  obtains  so  much  of  filling  them  up 
with  starchy  foods  which  their  digestive  apparatus 
is  unable  to  cope  with.  No  wonder  that  from  160 
to  200  infants  should  perish  in  the  first  year  out  of 
every  1000  born.  Even  if  we  think  that  two  or 
three  meals  a  day  are  too  few  for  infants,  four  are 
in  most  cases  quite  enough,  say  about  8  a.m.,  12 
noon,  and  4  and  8  p.m.,  with  one  feed  in  the  night. 
And  no  starchy  food  at  all  is  required  or  should  be 
given  for  at  least  the  first  nine  months  of  life,  after 
which  it  should  be  given  only  once  a  day,  milk 
being  used  at  the  other  diets. 

I  think  I  ought  now  to  say  something  about 
the  growth  of  children  in  reference  to  feeding. 
The  fact  that  a  child  is  growing  makes,  no  doubt, 
an  important  difference  in  comparing  its  feeding 
problem  with  that  of  a  full  grown  adult.  But  to 
how  much  does  this  amount  ?  A  baby  weighing 
say  7  lbs.  at  birth  loses,  as  a  rule,  nearly  a  pound 
in  weight  in  the  first  three  days,  after  which  it 
gains  on  the  whole  steadily  (though  sometimes  in 
the  intermittent  way  which,  as  we  have  more  than 
once  seen,  characterises  the  movement  of  organic 
phenomena  on  this  planet),  till,  in  twenty  days,  it 
will  weigh  nearly  8  lbs.  ;  at  the  end  of  a  month 
about  8J  lbs.  ;  at  the  end  of  two  months  about 
10|-  lbs.  ;  at  the  end  of  three  months  about  12 J  lbs.  ; 
at  the  end  of  six  months  about  16  lbs.  ;  and  at  the 
end  of  the  first  year  of  life  about  20  lbs.     In  one 


358 

sense  the  gain  is  immense,  because  a  baby  weighs  at 
the  end  of  a  year  nearly  three  times  its  weight  at 
birth,  and  this  must  no  doubt  mean  great  develop- 
mental activity  in  every  part  of  the  growing  body. 
I  dare  say  that  this  great  nutritional  activity  and 
the  changes  it  implies  form  a  main  part  of  the 
cause  of  the  great  mortality  experienced  in  the  first 
year  of  life  ;  and  probably  to  this  must  be  added 
some  amount  of  hereditary  weakness  or  occasionally, 
inherited  disease.  But  in  another  sense  the  gain  in 
weight  from  7  to  20  lbs.  is  only  a  gain  of  13  lbs.  in 
a  year.  This  again  is  about  a  pound  a  month,  or 
about  half  an  ounce  a  day  on  the  average.  We 
may,  however,  suppose  that  some  overplus  of  food 
ought  to  be  ingested  into  the  growing  body,  over 
and  above  absolute  necessity,  and  we  may,  therefore, 
in  response  to  this  demand  (a  reasonable  one  I 
think),  say  that  we  ought  to  supply  as  much  food 
as  will  afford  one  ounce  a-day  or  even  one  and  half 
ounce  in  addition  to  that  required  for  subsistence. 
I  do  not  know  how  this  will  strike  the  reader,  but  I 
think  she  will  say  that  the  requirement  is  a  good 
deal  less  than  she  expected  it  to  be.  Considering  the 
composition  of  milk  and  of  body-tissues  respectively, 
this  demand  for  growth  amounts  to  say  three  or 
four  ounces  of  milk  daily  in  addition  to  what  is 
required  for  subsistence.  What  I  suggest  is,  that, 
under  the  demand  for  food  for  increase  of  growth, 
a  demand  vague,  and  because  vague,  usually  much 
in  excess  of  requirements,  a  great  deal  more  food  is 
given  to  babies,  in  order  to  meet  this  growth-demand, 


359 

than  the  three  or  four  ounces  of  extra  milk  which 
they  require  for  this  purpose.  The  consequence  of 
this  is  a  great  deal  of  mal-assimilation  of  food 
or  of  indigestion,  shewing  itself  in  flatulence,  pain, 
griping,  constipation  or  diarrhoea,  or  in  disturbed 
and  irregular  sleep,  and  in  various  "colds,"  and 
tongue — mouth — or  throat — troubles.  Mothers,  and 
especially  young  mothers,  are  so  anxious  to  do  well 
by  their  babies,  that  they  do  too  much  for  them  ; 
they  overdo,  and  the  children  sufler.  Of  course 
children  are  sometimes  neglected,  but  this  is  a  much 
rarer  form  of  error  than  the  other ;  albeit  that  it 
shocks  us  very  much  in  those  comparatively  rare 
cases  in  which  it  occurs.  Perhaps  a  mixture  of 
neglect  and  of  over-indulgence  is  the  commonest 
form  of  error  in  the  treatment  of  infants,  too 
long  intervals  between  meals  at  one  period  of  time 
being  attempted  to  be  made  up  by  too  frequent 
feedings  at  another.  But  this  form  of  error  is  often 
fatal ;  and  it  really  would  be  better  if,  by  any 
chance,  baby,  who  ought  to  have  been  fed  in  four 
hours,  has  had  to  wait  six,  to  give  it  its  food 
then,  and  to  wait  the  full  four  hours  next  time,  than 
to  feed  say  in  two  hours  again,  or  even  in  three,  in 
order  to  make  up  for  the  previous  omission.  Clear 
ideas,  then,  regarding  growth,  its  rate,  and  its 
amount,  would  vastly  help  us  in  managing  the 
nutrition  of  infants,  and  would  tend  to  prevent 
the  over-feeding  and  the  too  frequent  feeding  which 
are  so  common  a  cause  of  illness  and  of  mortality 
among  them.     While  I  am  considering  this  subject, 


360 

I  should  like  to  add  some  similar  considerations 
regarding  the  nutrition  of  growing  children,  say  at 
ages  beyond  the  first  year.  A  growing  boy  or  girl, 
we  are  constantly  hearing,  ought  to  be  well  fed. 
Yes ;  so  they  ought ;  but  how  well  ought  they  to  be 
fed?  That  is  the  question.  Comparatively  few 
observations  have  been  published  upon  the  weight 
of  children  from  the  second  to  the  fifth  year  of  life. 
But  from  372  observations  made  by  Professor  Holt, 
of  New  York,  it  appears  that  the  gain  in  weight  is 
about  six  pounds  during  the  second  year,  about  four 
and  a  half  during  the  third  year,  and  about  four 
pounds  during  the  fourth  year.  During  this  period 
the  gain  is  rarely  steady  even  in  the  second  year. 
With  most  children  it  is  slowest,  or  the  weight  is 
stationary,  in  the  summer  months,  while  the  most 
rapid  increase  is  usually  seen  in  the  autumn. 
Throughout  this  period  girls  gain  in  about  the  same 
ratio  as  boys,  but  remain  on  the  average  nearly  one 
pound  lighter.  *  *  During  almost  every  illness,  no 
matter  of  what  character,"  says  Professor  Holt, 
' '  the  gain  in  weight  ceases,  and  usually  there  is  a 
loss,  the  rapidity  and  extent  of  which  are  somewhat 
proportionate  to  the  severity  of  the  attack  ;  but  it 
is  always  much  more  rapid  in  diseases  of  the 
digestive  tract  than  in  any  other  form  of  illness." 
The  reader  who  has  entered  into  the  spirit  of  the 
observations  characterising  this  essay,  will  have  no 
difficulty  in  seeing  how  these  remarks  coincide  with 
it,  or  in  perceiving  that  I  look  upon  the  rapid  loss 
of  weight  in  children's  illnesses  as  generally  caused 


361 

by  the  too  rapid  accumulation  in  their  blood  and 
tissues  of  ill-assimilated  food  stufi,   converted  into 
ill-made  body  stuft'.     This  ill-made  body  stuff  is  apt 
on  exposure  to  a  variety  of  the  ills  of  life,  to  cold, 
wetness,    wind,  damp,  or  fatigue,  which,  do  as  we 
will,  cannot  always  be  prevented,  to  die,  break  down 
with  excessive  combustion  or  fever,  and  require  to 
be  eliminated  from  the  body.     If  we  translate  this 
statement  into  the  language  with  which  we  are  now 
familiar,  we  may  say,  that  exposure  of  infants   to 
the  exciting  causes  of  cold,  wet,  damp,  fatigue,  &c. , 
is  apt   to   have   very    hurtful   influences   on   their 
health,  but  that  these  hurtful  influences  are  apt  to 
be  much  aggravated  if  in  addition  they  have  been 
subjected  to  the  action  of  the  predisposing  cause  of 
wrong  feeding,  and,  as  is  so  commonly  the  case,  of 
over-feeding,     that    is,     of    too    frequent    or    too 
abundant  feeding.     The  principle,  therefore,  which 
determines  the  occurrence  of  the  large  majority  of 
the  diseases  from  which  infants  and  children  suffer 
is    just    the    same    as    that    which    causes     their 
occurrence   in  grown  persons,   viz.,    wrong  feeding, 
the     considerations     advanced     regarding     normal 
increase  of  weight  in  infants  exactly  and  strongly 
corroborating  this  view.     Even  the  beggar's  baby, 
as    has    been    already    said,    is    under    the    same 
influences ;  too  frequent  feeding,  and  that  generally 
with   improper  sorts  of    food  (particularly  starchy 
foods)  being  the  chief  cause  of  its  illnesses. 

As    regards    the    increase   of    weight    beyond 
the    age   of    five   years,  the   following   table   from 


362 

Bowditch,  referring  to  American  children,  will  shew 
at  a  glance  the  facts.  The  height  and  circumference 
of  the  head  and  chest  increase  proportionately  to 
the  increase  in  weight,  but  I  have  not  inserted 
them  in  the  table. 

Weight  op  Childben  from  Five  to  Sixteen  Yeabs 


OF  Age. 

Age 

5  yej 

Boys. 
Pounds.           Kilos. 

irs      ...       41-2         18-71 

Girls. 

Pounds.           Kilos. 

39-8        18-06 

6     , 

...       45-1 

20-48 

43-8        19-87 

7      , 

...       49-5 

22-44 

48           21-78 

8      , 

...       54-5 

24-70 

52-9         24-01 

9     , 

...       60-0 

26-58 

57-5         26-10 

10     , 

...       66-6 

30-22 

64-1         29-07 

11      , 

...       72-4 

32-83 

70-3        31-87 

12      , 

...       79-8 

35-21 

81-4        36-90 

13      , 

...       88-3 

40-04 

91-2         41-36 

14      , 

...       99-3 

45-03 

.       100-3         45-50 

15      , 

...     110-8 

50-26 

.       108-4         49-17 

16      , 

...     123-7 

56-09 

.       113-0         51-24 

The  slowest  gain  is  from  the  fifth  to  the  eighth 
year,  when  it  is  about  four  pounds  a  year.  From 
the  eighth  to  the  eleventh  year  it  rises  to  about  six 
pounds  a  year.  Up  to  the  eleventh  year  the  two 
sexes  gain  in  about  the  same  ratio.  From  the 
eleventh  to  the  thirteenth  year  the  girls  gain  much 
more  rapidly,  passing  the  boys  for  the  first  time, 
and  maintaining  this  lead  until  the  fifteenth  year, 
when  again  the  boys  pass  them.  But  the  rate  of 
increase  for  boys  and  girls  alike  emphasises  the 
truth  of  the  considerations  I  have  advanced 
regarding    the    need   for    feeding   for   growth,    and 


363 

the  comparatively  small  amount  of  extra  food 
required  on  this  account.  As  a  fact,  growing  boys 
and  girls  are  frequently  supplied,  not  with  half  an 
ounce  of  extra  food  daily  to  allow  them  to  grow, 
nor  with  an  ounce,  or  even  two,  three  or  four 
ounces,  but,  on  the  ground  that  they  are  growing, 
are  not  infrequently  provided  with  an  extra  half 
pound  of  food  three  times  a  day ;  and,  in  conse- 
quence, most  disastrous  results  not  infrequently 
occur. 

I  might  say  here,  in  a  parenthesis,  as  it  were, 
that  exactly  the  same  principles  determine  or  ought 
to  determine  the  kind  of  advice  that  ought  to  be 
offered  to  the  expectant  mother,  so  often  advised 
and  even  besought  by  her  friends  to  "  eat  for  two." 
As  in  nine  months  there  is  brought  forth  a  product 
weighing  altogether  about  nine  pounds,  the  problem 
of  properly  feeding  her  is  very  similar  to  that  of 
feeding  the  growing  boy  or  girl,  and  amounts  to  an 
extra  quantity  of  between  half  an  ounce  and  an 
ounce  a  day.  Even  if  the  gross  weight  at  birth 
were  18  pounds  (and  it  occasionally  approximates 
to  this  weight),  the  extra  necessity  of  food-supply 
would  only  amount  to  about  an  ounce  a  day.  But 
the  vaguest  ideas  being  current  as  to  this  necessity, 
well-meaning  but  injudicious  friends  press  upon  her 
the  advice  to  perhaps  interpolate  an  extra  meal  or 
even  two  in  the  day,  and  to  increase  her  normal 
food  supplies  besides,  so  that  in  order  to  meet  a 
necessity  of  an  extra  supply  of  an  ounce,  or  say 
two  ounces,  of  food  daily,  perhaps  an  extra  one  and 


364 

a  half  pounds  avoirdupois  may  be  ingested  and 
consumed.  The  consequences  of  this  only  those 
know  or  can  appreciate  whose  business  it  is  to  bear 
on  their  shoulders  the  responsibility  for  disasters 
occurring  at  parturition  —  disasters  of  the  most 
calamitous  kind,  which  always  evoke,  as  they  ought 
to  do,  the  widest  spread  sympathy,  too  often 
accompanied  by  execrations  of  nurse  and  doctor, 
who  did  or  did  not  do  this,  that  or  the  other  trifle, 
the  doing  or  not  doing  of  which  led,  in  common 
opinion,  to  the  calamitous  occurrence.  It  is  not  the 
lighting  or  not  lighting  of  the  fire  at  a  given 
moment,  nor  is  it  the  opening  or  not  opening  of  a 
window  or  of  a  door,  causing  a  draft  on  the  one 
hand  or  too  much  stufiiness  on  the  other  ;  nor  yet 
is  it  the  bringing  of  a  certain  meal  five  minutes 
after  its  proper  time — it  is  not  any  of  these  trifles 
which  does  the  mischief,  although  all  things  ought 
to  be  done,  no  doubt,  decently  and  in  order ;  but 
it  is  the  improper  habits  of  the  patient  herself,  and 
particularly  the  unsuitability  of  her  food  habits, 
before  her  confinement,  which  is  the  main  cause  of 
her  disasters.  The  exciting  causes  named  may 
indeed  be  the  occasion  of  the  calamity — they  may 
be  a  part  or  a  small  part  of  the  cause  ;  but  the 
cause,  or  the  main  part  of  it,  without  whose 
existence  the  slight  or  exciting  causes  would  have 
been  powerless  for  evil,  is  the  state  of  the  patient 
herself,  brought  about  by  the  action  of  causes  so 
simple  as  to  be  within  the  observing  power  of 
the     meanest     intellect,      and     yet,      perhaps     for 


365 

that     very     reason,     overlooked     or     ignored     by 
almost  all. 

If  we  keep  in  mind  the  principles  which  ought 
to    guide    us,     we    shall   have    little   dijficulty    in 
answering  the  question  so  often  put  to  us,  how  often 
do  children  require  to  be  fed  ?     I  have  already  dealt 
with  infancy.     After  two  years  of  age  a  child  ought 
to  be  got  on  to  three  meals  daily  without  any  inter- 
polation    of    extra     meals,     without     addition     of 
chocolates,  spice,  cakes,  &c.,  if  we   wish   it   to   be 
well,     and     to      exemplify     and     maintain     those 
characteristics  which  seem   to  make   the  period  of 
from  two  to  four  years  of  age  the  very  acme   and 
perfection  of  childhood.      Nothing  probably  is  more 
interesting    and  attractive  in   the  whole   range  of 
human  experience   than   to   watch  the   opening  of 
childhood's  faculties  at  this  age,   to  hear  the  early 
attempts  at  connected  speech,  as  nerve  cells  in  the 
brain  become  connected  with  one  another  so   as  to 
form  the  mechanism   through   which   the   growing 
powers  of  mind  can  be  better  and  better  exercised. 
Equally  interesting  is  it  to  watch  the  development 
of  the  moral  and  spiritual  and  the  emotional  nature, 
as  by  leaps  and  bounds  in  an  intermittent,  but,   on 
the  whole,  progressive  way,  it  opens  up  before  us ; 
similar  changes  in  the  posterior  parts  of  the  brain 
taking  place,  so  as  to  allow  of  the  manifestation  of 
these  qualities,  and  of  remembering,   judging,   &c., 
as  took  place  in  the  anterior  portions  to  allow  of 
feeling  and  perception.     But  if  these  faculties  are  to 
grow  and  develope  from  early  promise  to  maturer 


366 

fulfilment,  how  important  it  is  that  from  the  earliest 
age  the  necessity  of  self-government  should  be  put 
before  the  child,  how  necessary  that  it  should  be 
taught  that,  while  learning  its  needs  from  the 
impulses  of  nature  and  of  desire,  it  should  early 
learn  to  put  restraint  and  government  upon  them. 
And  until  this  is  possible,  how  necessary  that 
parents  and  guardians,  who  stand  to  children  in  the 
same  relation  as  divine  providence  to  children  of  a 
larger  growth,  how  necessary  for  them  to  make  the 
conditions  as  suitable,  and  natural,  and  healthy  as 
possible.  The  same  considerations  obtain  and 
ought  to  weigh  with  us  in  feeding  the  growing  and 
developing  cerebral  organism  as  obtain  in  the  case 
of  the  nutrition  of  older  persons ;  only  this  is,  if 
possible,  more  important  in  the  case  of  children  so 
delicate  and  so  tender.  If,  for  example,  they  have 
a  great  love  of  sweets,  this  should  be  gratified — 
it  was  not  implanted  in  them  by  nature  for 
nothing — but  it  should  be  gratified  in  moderation, 
say  by  giving  one  or  two  of  the  coveted  edibles  at 
meal  times,  and  not  between  meals,  so  that  they 
shall  be  digested  and  properly  assimilated  with  the 
food,  and  not  go  to  form  subidiary  meals.  For,  if 
they  do  the  last,  how  can  the  blood  fail  to  be  loaded 
with  waste  and  effete,  or,  at  least,  with  ill- 
made  and  imperfectly  assimilated  food  stuffs  ?  And 
when  this  is  so,  how  can  we  expect  that  the  blood 
will  either  nourish  the  body  properly  or  secrete  the 
fine  spirituous  fluid  l3^ng  in  the  ventricles  of  the 
brain,  and  between  the  membranes  of  the  brain  and 


367 

spinal  cord,  so  that  the  functions  of  these  governing 
and  controlling  parts  of  the  body  shall  not  fail  of 
their  high  place  and  power  ?  Will  not  that  fine 
spirituous  fluid  tend  in  such  circumstances  to 
become  thick,  cloudy,  and  grumous,  and  so  to  spoil 
the  development  and  growth  of  those  very  faculties 
whose  proper  growth  is  of  so  great  consequence  to 
their  possessors,  and  of  interest  so  intense  to 
on-lookers  ?  That  there  must  be  something  wrong 
in  the  way  in  which  children  are  generally  fed  will 
be  apparent  to  whoever  calls  to  mind  and  reflects 
upon  her  experience  on  seeing  her  child  in  the  early 
morning,  and  on  discovering  from  the  morning  kiss 
how  unpleasant  (not  to  use  a  stronger  term)  is  the 
child's  breath.  It  ought  not  to  be  so,  but  the 
breath  is  too  often  faint  and  mal-odorous  in  place  of 
sweet  and  fragrant.  This  must  mean  mal-assimila- 
tion  of  food,  and  mal-assimilation  of  food  must,  in 
turn,  result  in  imperfect  formation  of  bodily  and 
cerebral  tissue,  in  other  words,  in  improper  growth 
of  the  child's  tender  body  and  brain,  and  in  marked 
instability  of  tissue,  which  is  therefore  far  proner 
than  it  ought  to  be  to  break  down  with  excess  of 
combustion  and  oxidation,  and  to  induce  one  of 
those  inflammatory  or  febrile  attacks  which  are  so 
characteristic  of  childhood. 

I  will  not  say  any  more  about  the  interest  and 
even  fascination  which  characterise  the  growth  of 
body  and  mind  in  early  life ;  nor  will  I  say  anything 
more  about  the  gravity  of  the  responsibility 
undertaken  by  parents  in  the  rearing  and  education 


368 

of  their  children.  Truly,  when  we  come  to  reflect 
upon  it,  we  are  driven  to  exclaim  :  "  who  is 
sufficient  for  these  things  ?  "  But  I  will,  coming 
down  again  to  the  lower  physical  and  organic  basis 
on  which  the  higher  qualities  are  founded,  and 
through  which  they  work,  consider  a  little  further 
the  number  of  meals  proper  to  childhood,  and  how 
best  to  meet  the  indications  of  physiology  and  of 
nature  in  the  circumstances  of  modern  civilisation 
in  towns.  I  do  hope  I  may  carry  medical  opinion 
with  me  in  the  view  I  am  enunciating.  I  do  know 
that  some  able  medical  authorities  agree  with  me 
in  thinking  that  three  meals  a  day  are  sufficient  for 
children  in  all  circumstances,  and  that  in  no  case, 
therefore,  should  the  practice  be  resorted  to  of 
providing  them  with  more.  If,  for  instance, 
children  of  from  five  to  fifteen  years  of  age 
breakfast  at  eight,  go  to  school  at  nine,  and  dine  at 
12-30  or  one,  they  should  in  my  view  not  be 
encouraged  or  even  allowed  to  eat  anything  at  the 
ten  minutes'  break  during  school  hours  at  11  p.m. 
At  the  most,  they  might  have  a  glass  of  milk  and 
hot  water,  equal  parts,  at  that  time,  although  I 
really  think  a  glass  of  water  alone  would  be 
better  for  them,  since  it  would  stimulate  the 
stomach,  and  the  digestive  organs  generally,  to 
finish  the  digestion  of  breakfast  before  dinner  was 
due.  The  digestive  organs  would  thus  have  more 
rest,  the  blood-making  processes  would  be  better 
performed,  and  fewer  causes  of  "  colds "  and 
feverish  attacks  would  be  present  in  the  body  and 


369 

blood ;  while  dinner  at  its  proper  time  would  be 
better  enjoyed  and  better  assimilated.  As  to  the 
habit,  not  uncommonly  indulged  in,  of  taking  tarts 
and  milk  at  eleven  o'clock,  it  is  a  pernicious  custom, 
which  I  am  quite  sure  ought  to  be  abolished.  It 
leads  to  many  colds  and  many  illnesses,  fevers 
among  the  rest,  the  causes  of  which  are  apt,  as  we 
have  already  often  seen,  to  be  attributed  to  cold, 
wetness,  fatigue,  &c.,  on  the  one  hand,  and  to  that 
bugbear  of  modern  life,  "  infection,"  on  the  other. 
If  only  parents  and  the  public  generally  could  be 
induced  to  see  that  when  small  amounts  of  exposure 
to  cold,  rain,  wind,  and  the  like,  give  children 
"  colds,"  and  that  when  small  and  often  scarcely 
discoverable  amounts  of  exposure  to  infection  give 
them  "fevers,"  the  predisposing  conditions  as  to 
feeding  ought  to  be  carefully  considered  and 
examined,  how  much  benefit  might  be  obtained. 
Sometimes,  it  seems  to  me,  the  "  infection "  is 
boldly  invented,  when  a  "fever"  has  to  be 
accounted  for.  A  child,  for  instance,  is,  say,  six 
months  in  hospital  when  it  developes  scarlatina  or 
diphtheria.  At  once  infection  is  looked  for. 
A  visitor,  it  is  said,  must  have  brought  the 
infection.  This  is  assumed  as  an  unquestionable 
axiom.  Careful  inquiry  is  made.  Someone  who 
visited  the  child  is  proved,  or  is  suspected 
to  have  been  in  communication  with  someone 
who  has  had  scarlatina  or  diphtheria,  and  in 
this  obscure  and  subtle  way  the  infection,  it  is 
inferred,  has  been  introduced  into  the  ward.     The 


370 

idea  that  the  child  might  have  developed  the  fever 
because  say  a  germ  or  two  of  the  infecting  cause 
was  swallowed  in  milk  or  eaten  in  food,  and,  finding 
in  the  over-fed  body  a  suitable  nidus  or  soil,  took  to 
growing  in  the  blood  or  tissues,  is  never  considered. 
Nor  is  it  considered,  as  it  ought  to  be,  that 
if  a  cause  so  slight  as  the  vague  exposure  to 
infection  on  the  one  hand,  or  the  introduction  into 
the  organism  of  a  germ  or  two  on  the  other, 
suffices  to  give  a  child  a  fever,  the  cause,  or  its 
main  part,  ought  to  be  looked  for,  not  in  the 
introduction  of  the  germ,  but  in  the  predisposition 
of  the  soil,  that  is,  the  state  of  the  blood  and 
tissues  of  the  child,  to  stimulate  its  growth.  Of 
course,  I  do  not  suggest  that  the  germ  was  created 
by  the  suitability  of  the  soil  to  favour  its  growth. 
The  germ  was  not  created  by  the  soil,  but  it  was,  I 
believe,  attracted  by  it.  Or  the  germ  may  have 
been  lying  dormant  in  the  soil  (that  is,  the  body), 
and,  finding  a  suitable  pabulum  in  its  wrongly  fed 
state,  or  over-manured  state,  took  to  growing  in  it. 
Now  this  is  no  imaginary  case.  I  saw  not  long  ago 
a  little  girl,  five  years  of  age,  pale,  thin,  delicate, 
refined,  and  her  mother  told  me  that  the  child 
could  not  eat.  "  She  only  picks,"  she  said,  "  like  a 
dickey  bird."  And  quite  recently  the  child  had 
had  typhoid  fever — at  least,  so  it  was  said — and  a 
doctor  had  attended  her  for  it.  Whether  the  child 
had  typhoid  fever  or  not,  it  was  well  that  that 
opinion  was  formed  and  acted  upon,  because,  as  is 
well  known,  the  best  treatment  for  that  condition  is. 


371 

an  exclusive  milk  diet  for  several  weeks,  three,  say, 
to  six,  and  sometimes  nine,  and  very  occasionally 
even  twelve.  If  only  the  milk  is  kept  down  to 
small  amounts,  say  to  a  pint  or  so  a  day,  diluted 
with  hot  water  so  as  to  make  it  easier  of  assimila- 
tion, and  to  let  it  be  administered  at  the  comfortable 
and  convenient  temperature  of  about  70°  F.,  with 
perhaps  half  a  pint  of  mutton  tea  or  chicken  tea  in 
addition  in  the  24  hours — if  anything  is  wanted 
in  the  night,  water  is  best,  for  the  stomach 
and  digestive  organs  require  rest  as  well  as  the 
other  parts  of  the  body — nothing  but  good  can 
result.  The  child  in  question  had  been  treated  in 
this  way,  and  had  in  due  course  recovered,  her 
appetite  returning  in  a  more  healthy  way  than 
before  the  illness.  By  and  bye,  however,  the 
delicate  and  refined  little  thing  began  to  want  less 
food,  and  the  mother  became  alarmed.  In  order  to 
make  up  for  a  poor  breakfast,  she  served  the  child 
with  lunch  at  10-30  a.m.  of  bread  and  milk,  a 
wholesome  food  enough,  but  given  at  the  wrong 
time,  especially  as  the  child  was  expected  to  eat 
dinner  at  one.  Naturally  enough  the  dinner  meal 
was  refused,  or  a  mere  pretence  was  made  to  eat  it. 
The  mother  being  again  alarmed  lest  the  child 
should  die  of  starvation,  had  some  more  food  served 
at  four  o'clock,  and  again  at  six.  The  child  was 
having  not  too  little  done  for  her  but  too  much. 
Injudiciously,  but  well  meaningly,  no  doubt,  she 
was  having  too  many  meals  forced  on  to  her,  and 
the   consequence   was   that   her   digestion    became 

X2 


372 

entirely  upset  and  deranged,  her  tongue  became 
furred  and  dirty,  and  her  appetite  almost  wholly 
disappeared.  I  recommended  that  she  should  be 
put  to  bed  and  fed  as  if  she  had  typhoid  fever.  I 
did  not  say  she  had  typhoid  fever,  because  I  did  not 
think  she  had  ;  but  I  put  her  to  bed  and  recom- 
mended poultices  or  compresses  to  her  stomach 
regularly  for  an  hour,  twice  a  day,  with  a  cool 
evaporating  lotion  to  the  head  at  the  same  time, 
and  suggested  giving  not  more  than  a  pint  of  milk 
well  diluted  with  water,  and  nothing  else,  in  the  24 
hours,  and  going  on  with  this  until  the  child  began 
to  call  out  for  something  to  eat.  This  she  did  in 
about  a  fortnight,  when,  her  tongue  being  clean 
enough  to  make  it  seem  right,  she  had  some  dinner 
given  her.  The  milk  was  continued  as  before, 
morning  and  evening,  and  the  dinner  was  continued 
for  several  more  days.  After  this,  the  child  had  a 
little  bread  with  her  milk  about  six  o'clock,  and  soon 
became  quite  well,  with  a  reasonable  appetite  for 
her  dinner  between  twelve  and  one,  and  for  her 
"  tea "  between  five  and  six  p.m.  As  she  was  a 
delicate  child,  with  a  low  resistance  to  digestive 
labour,  I  recommended  continuing  this,  really  a 
two-meal-a-day  plan,  for  some  time ;  and  said  I 
thought  it  would  be  well  if  this  course  were 
adhered  to  for  the  future.  Sometimes  mothers  are 
convinced  by  this  sort  of  reasoning,  and  sometimes 
not.  For  some  reason  (perhaps  because  general 
medical  opinion,  and  particularly  the  prejudices  of 
friends,  are  violently  opposed  to  it)  it  is  sometimes 


373 

very  difficult  to  persuade  them  to  continue  in  this 
way,  even  although  one  can  point  to  the  facts  that 
the  child  is  doing  well,  plays  with  energy,  and  has 
a  better  colour,  and  more  regular  intestinal  action, 
and  that  she  wakes  also  with  a  sweeter  breath  in 
the  morning,  and  also  that  she  is  gaining  weight. 
Notwithstanding  these  clear  evidences  that  things 
are  going  on  quite  well,  in  some  cases  mothers  will 
not  be  convinced  that  they  ought  to  let  well  alone. 
They  begin  again  with  the  10-30  meal  "to  keep  the 
child's  strength  up,  and  to  allow  for  growth,"  and 
they  begin  the  day  with  breakfast  at  eight  or  8-30 
besides.  In  not  a  few  cases,  after  one  had  been 
able  to  persuade  the  mother  into  rational  ways  of 
feeding  children,  grandmother  has  appeared  on  the 
scene  and  has  sternly  forbidden  the  continuance  of 
the  "pining  process."  Occasionally  even  the  father 
has  assumed  this  responsibility.  Opinion  is  divided, 
as  it  was  in  Middlemarch,  we  are  told,  between  Dr. 
Wrench  and  "the  strengthening  treatment,"  on  the 
one  hand,  and  Toller  and  "  the  lowering  system,"  on 
the  other  ;  or  we  are  reminded  of  the  competition  in 
Milby  between  Mr.  Pilgrim  and  Mr.  Pratt,  "  the 
latter  of  whom  elegantly  referred  all  diseases  to 
debility,  and,  with  a  proper  contempt  for  symp- 
tomatic treatment,  went  to  the  root  of  the  matter 
with  port  wine  and  bark ;  while  Pilgrim  was 
persuaded  that  the  evil  principle  in  the  human 
system  was  plethora,  and  he  made  war  against  it 
with  cupping,  blistering  and  cathartics."  The 
present   writer   humbly   agrees    with   Mr.    Pilgrim 


374 

in  his  view,  though  not  in  his  practice  ;   faihng  to 
see  how   cathartics  can   clear  plethora  out   of  the 
blood   and   tissues,    although,    as   they   have   some 
influence  on  the  stomach   and  bowels,  they  might 
conceivably    clear    obstructions    out    of    these,    so 
ridding  the  system  of  the  materies  morbi,  if  it  had 
not  been  for  the  other  fact  that,  long  before,   the 
peccant  matter  had  been  passed  from  these  organs 
and   had    found   its   way  into  the  blood.     On  the 
other   hand,    Mr.    Pilgrim's   other  sheet-anchors  of 
blistering    and    cupping,    while    they   might    con- 
ceivably remove    effete   plethoric   material   from   a 
small   portion  of   the  blood,  or  even  remove  some 
of   that   vital    fluid    itself,    and   along   with    it    its 
deleterious  accompaniments,  could  not,  it  seems  to 
the  present  writer,  exert  any  effect  at  all  on  the 
rest  of  the  circulating  medium,  which  would  still 
continue    to    flow,    loaded   with    its    ill-made   and 
unused  stuff,  to  poison  the  tissues  of  the  body.     By 
restricting  the  diet,  however,  to  a  point  under  (for 
a  time)  what  is  required  for  the  maintenance  of  the 
body   in   health,   all   these  desirable  ends  may  be 
attained,    the    non-introduction    of    new    material 
compelling  the  organism  to  use  up  what  is  already 
in  it,   to  the  great    benefit  of  all  the  actors  and 
elements  concerned  in  the  problem.     But  in  Milby, 
as  in  the  rest  of  the  civilised  world,  it  is  apt  to  be 
"  the   strengthening    treatment "  which  commands 
the  favour  of  a  not   too  discerning  or  too  closely 
reasoning  popular  opinion.     "  Port  wine  and  bark," 
indeed,  acting   as   stimulants,    while    they   do    not 


375 

supply  the  materials  for  oxidisation  and  combustion 
required  by  the  body,  might  have  an  influence 
which  neither  Mr.  Pilgrim  nor  Mr.  Pratt,  nor  any 
of  their  respective  supporters  or  partisans  had  ever 
considered,  and  might  even  be  acting  favourably 
in  ways  unsuspected  either  by  the  supporters 
or  by  the  leaders  themselves.  A  diet,  in  fact, 
of  port  wine  and  bark,  or  of  alcohol  in  any  form, 
or  such  a  diet,  in  addition,  say,  to  a  pint  of  milk, 
and  of  soup  daily,  such  as  is  not  infrequently 
prescribed  for  patients  sufiering  from  various  forms 
of  fever  and  debility,  is  really  a  restricted  diet, 
although  it  is  called  a  stimulating  one.  Measured 
in  food  calories,  it  will  amount  to  perhaps  300  or 
400  food  calories,  as  against  the  2300  or  so  emitted 
by  the  starving  man,  or  by  the  physician  or  the 
professor,  or  the  literary  man  or  woman,  whose 
food  requirements  are  so  very  low,  as  we  have  seen. 
And  yet,  such  slaves  are  we  to  words,  that  a  diet 
amounting  in  food  value  to  only  a  fractional  part 
of  even  the  ounce  of  food- weight  required  daily  for 
every  ten  pounds  of  body- weight,  on  the  lowest 
computation,  for  the  nourishment  and  enrichment 
of  the  blood,  is  thought  of  by  us,  if  only  we  call  it 
"  a  stimulating  diet,"  as  one  in  excess,  and  not  as  it 
really  is,  in  deficiency. 

But  to  return  to  the  feeding  of  children  ;  it  is 
in  many  cases  quite  in  vain  to  reason  about  the 
am.ount  by  which  a  child  grows  in  a  year,  and  to 
say  how  much  extra  food  is  required  for  this 
purpose ;  and  equally  useless  to  point  to  the  various 


376 

marks  of  improvement,  and  to  shew  that  he  is 
gaining  weight.  The  quantity  of  food  which  ought 
to  be  given  to  a  growing  child  is  too  apt  to  be 
settled  by  prejudice  rather  than  by  reason  ;  and  it 
is  not  often  that  parents  can  be  induced  to  listen  to 
the  arguments  which  convinced  the  mother  of  the 
tuberculous  child  of  four  years,  formerly  referred 
to,  who  was  cured  of  her  necrosis  of  the  thigh  bone, 
and  white  swelling  of  the  knee  joint,  on  one  meal  a 
day  and  a  glass  of  milk  night  and  morning,  and 
who  gained  nearly  ten  pounds  in  weight  on  this 
diet  continued  for  fifteen  months.  That  the  two- 
meals-a-day  plan,  recommended  by  Dr.  Dewey,  is 
suitable  for  town-bred  children  in  England,  there 
can  be  little  doubt.  He  proposes  that  children 
should  go  to  school  at  say  eight  a.m.,  and  stay  there 
till  ten,  returning  home  then  for  breakfast.  He 
points  out  that,  their  organisms  not  being  troubled 
with  the  labour  of  digestion,  their  intellects  and 
perceptions  would  be  keen  to  take  in  and  to  remem- 
ber the  instruction  they  received.  At  ten  he  thinks 
they  should  go  home  to  breakfast.  At  eleven  they 
might  return  to  school.  I  would  suggest  that  they 
should  be  encouraged  to  play  under  cover  if  the 
weather  is  bad,  and  that  in  good  weather  they 
should  be  taken  out  into  the  country,  if  necessary  a 
short  distance  by  rail  in  the  case  of  large  towns,  to 
study  nature  under  the  general  superintendence  of 
teachers,  who  should  go  with  them  and  shew  them 
animals,  birds,  plants,  and  rocks,  in  a  conversational 
way,  interfering  no  further  with  their  libert}''  of  free 


377 

movement  than  might  be  necessary  to  preserve 
order  and  prevent  destruction  or  damage  to 
property.  At  one  or  two  p.m.  they  should  be  back 
in  school,  where  for  two  or  three  hours  more  they 
might,  by  the  help  of  books  and  maps,  follow  up 
the  studies  which  they  had  practically,  and  almost 
without  knowing  it,  begun  in  the  fields  and  in  the 
country.  The  scientific  and  orderly  arrangement 
of  knowledge,  begun  practically  through  eyes,  ears, 
and  fingers,  might  be  elaborated  and  carried  on  by 
the  help  of  books,  &c.  The  stomach  and  digestive 
viscera,  having  done  their  work,  the  brain  would 
not  be  distracted  by  having  to  superintend  digestive 
labour,  and  would  again,  therefore,  be  almost  as 
keen  and  receptive  of  instruction  as  it  was  from 
eight  to  ten  a.m.  In  these  two  stretches  of  two 
hours  each,  young  children  would  probably  learn  as 
much  as  they  are  capable  of  assimilating.  Older 
children  might  have  two  stretches  of  three  hours 
each,  or  perhaps  one  of  three  hours  and  one  of  two. 
At  four  they  should  go  home  to  dinner  of  varied 
and  mixed  diet,  and  at  six,  seven,  eight,  or  nine, 
they  might  go  to  bed,  according  to  age.  These 
seem  very  suitable  arrangements  to  make  children 
happy  and  healthy,  as  well  as  to  educate  them. 
The  numbers  of  children  of  school  age,  about  a 
sixth  of  the  total  population,  say  50,000  in  a  town 
with  300,000  inhabitants,  are  numerous  enough  to 
demand  arrangements  suitable  for  their  life,  and 
health,  and  happiness,  and  instruction;  and  there 
would,    it    seems    to    me,    be    little    difficulty   in 


378 

adapting  the  business  arrangements  of  the  parents 
so  as  to  make  them  suit  all  parties.  But  if  this  is 
thought  too  revolutionary  a  measure,  there  is 
nothing  to  hinder  the  present  arrangements  about 
breakfast  and  dinner,  at  eight  and  12-30  or  one, 
respectively,  to  be  continued,  and  that  the  children 
should  have  either  a  glass  of  milk  at  5-30  or  six,  or 
that  and  some  bread,  so  that  they  should  have  in  no 
case  more  than  three  meals  daily.  The  occurrence 
of  illness  might  reasonably  be  made  the  test  as  to 
whether  any  further  change  should  be  made.  As 
disease  is  more  often  induced  by  wrong  feeding,  and 
by  too  frequent  feeding,  than  by  any  other  cause, 
and  as  this  is  as  true  for  children  as  it  is  for  grown 
persons,  the  occurrence  of  illness  should  in  most 
cases  be  met  by  restriction  of  the  diet,  and  this 
could  best  be  effected  by  omitting  either  the 
morning  or  the  evening  meal,  and  substituting  for 
it  say  a  glass  of  milk.  In  these  cases  where  a 
three-meal-a-day  plan  (it  would  be  shorter  to  say  a 
trissiteous  plan)  suited,  we  could  follow  the  good 
conservative  rule  to  let  well  alone ;  but  in  no  case 
do  children  require  to  be  fed  oftener  than  three 
times  a  day.  I  do  not,  however,  even  in  the  case 
of  children,  conceal  my  own  preference  for  the 
two-meal-a-day  plan  (or  the  dissiteous  plan),  thinking 
that  they  would  be  healthier  on  two  meals  a  day 
than  on  three.  If,  however,  they  took  three  meals 
daily,  this  plan  might  be  continued  till  the  age  of 
21,  or  possibly  till  25,  after  which,  I  think  the  two- 
meal  regime  should  be  resorted  to,  say  till  the  age 


379 

of  50,  or  perhaps  55  years.  After  this,  I  believe,  in 
the  majority  of  cases,  one  moderate  meal  of  mixed 
diet,  taken  some  time  between  twelve  noon  and 
two  p.m,,  would  be  the  healthiest  plan.  This  could 
be  continued  to  advanced  age,  say  75-80.  After 
that  age,  many  aged  persons  I  have  known  have 
seemed  to  think  that  they  obtain  the  best  health 
results  if  they  take  a  very  little  food  three  or  four 
times  a  day ;  and  one  ought  to  be  careful  of 
recommending  a  line  of  treatment  contrary  to  the 
views  of  those  whose  experience  entitles  them  to 
know.  True,  the  persons  whom  we  meet  who  have 
attained  advanced  age,  have  seldom  done  so  on  a 
two-meal-a-day  plan,  or  on  a  one-meal-a-day  plan. 
It  might  be  otherwise  if  they  had.  They  have 
generally,  however,  done  so  on  a  somewhat 
abstemious  diet,  as  Cornaro's  case  so  markedly 
exemplified.  There  are,  no  doubt,  exceptions  to 
every  rule,  and  one  finds  a  few  aged  persons  who 
have  eaten  freely  all  their  lives,  just  as  one 
occasionally  finds  also  persons  taking  alcohoHc  drink 
freely  and  still  surviving  to  old  age.  But  these 
cases  do  not  form  the  majority,  and,  when  they  are 
found,  one  is  disposed  to  ask  the  question,  how  much 
better  might  they  not  have  been  if  they  had  kept 
better  within  the  bounds  of  moderation.  That  old 
people  bear  abstinence  well  is  a  very  ancient 
observation,  followed  in  the  next  sentence  by  the 
statement  that  they  bear  over-feeding  badly,  or,  as 
the  ancient  writer  put  it,  seeing  the  paradox  which 
has  occupied  us  so  long  in  a  former  part  of   this 


380 

essay,  they  waste  or  consume  away  by  much  (yno 
fxev  yap  Tro\\(i)v  airoa- ^ivvvvr ai).  And  as  there  is 
no  strict  line  of  demarcation  between  infancy  and 
childhood,  nor  between  childhood  and  adolescence> 
and  maturity,  and  elderliness,  and  old  age,  each  age 
insensibly  leading  on  to  the  one  beyond  it, 
temperance  and  restraint  in  the  use  of  food  seem  to 
be  the  best  means  to  be  followed  by  humanity  at 
all  its  stages  of  progress  from  the  cradle  to  the 
grave,  if  life  is  to  be  healthy,  happy,  and  useful. 


381 


CHAPTER    XL 


On    Cancer. 


T  HAVE  thought  it  well  to  introduce  a  chapter 
on  cancer,  because  it  is  occupying  a  large 
amount  of  public  attention  at  the  present  time. 
Perhaps  I  ought  not  to  say  that  it  occupies  a  large 
amount  of  public  attention.  I  ought  rather,  I 
think,  to  say  that  it  is  causing  a  large  amount  of 
public  panic.  I  wish  cancer  did  occupy  a  larger 
share  of  public  attention,  because  I  have  come  to 
think,  and  the  reader  who  has  cared  to  accompany 
me  so  far  will  be  prepared  for  the  statement,  that 
cancer  is  not  a  diseased  condition  of  body  to  be 
considered  by  itself;  but,  on  the  other  hand,  being 
only  one  of  a  large  number  of  diseases  that 
overtake  humanity,  and  obeying  the  same  laws  as 
other  diseases,  it  is  induced  by  similar  causes, 
and,  like  them,  though  not  often  cured,  to  a  very 
large  extent  it  is  obviable  or  preventible,  and 
this  by  the  simplest  means.  I  share  the  general 
opinion  of  the  greatest  of  medical  writers,  as  the 
reader  will  have  observed,  that  disease  is,  on  the 
whole,  one  ;  and  I  venture  to  translate  this  opinion 
practically  into  the  view  that  on  the  whole  the 
causes  of  disease,  of  all  diseases,  are  the  same,  and, 


382 

therefore,  that  the  means,  if  not  of  curing,  at  any 
rate  of  preventing  cancer,  are  the  same  as  the 
means  of  preventing  other  diseases.  Therefore, 
also,  I  beHeve  that  proper  attention  to  air,  food 
and  exercises  would  do  as  much  for  us  in  preventing 
cancer  as  it  would  or  could  do  for  us  in  the  case  of 
other  diseases.  It  seems  to  me  a  very  simple 
matter ;  theoretically,  I  mean,  for  practically  it 
involves  the  problem  of  self  government,  it  involves 
a  certain  amount  of  self  restraint ;  and  no  one  who 
thinks  about  that,  or  studies  his  own  nature,  can 
fail  to  perceive  that  that  (while  it  is  the  main 
problem  in  life)  is  at  once  the  simplest  and  yet  the 
most  difficult  of  all  problems.  Panic  is,  however, 
the  least  favourable  attitude  of  mind  in  which  to 
approach  the  consideration  of  any  subject.  I 
deprecate  panic  in  the  consideration  of  this  one. 
In  the  number  of  deaths  which  it  causes,  cancer  is 
not  even  one  of  the  most  important  of  the  diseases 
to  which  humanity  succumbs.  If  we  consider  the 
effects  of  the  fevers,  of  consumption,  and  of  cancer, 
on  the  people  of  England,  we  may  roughly  say  that 
fevers  cause  four  deaths  for  every  one  caused  by 
cancer,  and  that  consumption  causes  two  for  every 
one  of  cancer.  That  is  to  say,  cancer  causes  only 
half  of  the  mortality  caused  by  consumption,  and 
only  one  quarter  of  the  mortality  caused  by  the 
fevers.  But  we  have  on  the  whole  greatly 
diminished  the  incidence  and  the  mortality  both  of 
the  fevers  and  of  consumption ;  and  there  is, 
therefore,  on  the  face  of  it,  no  reason  to  fear  that 


383 

we  shall  be  able  to  do  the  same  for  cancer.  I  have 
not  the  slightest  doubt  of  this  myself.  Neither  do 
I  think  that  it  is  necessary  for  us  to  raise  either  a 
million  pounds  sterHng  or  a  hundred  thousand 
pounds  in  order  to  do  this.  Any  results  to  be 
obtained  by  expensive  laboratory  work,  by  micro- 
scopic and  bacteriological  inquiry,  seem  to  me  more 
or  less  useless,  practically,  or  from  the  point  of  view 
of  the  causation  and  prevention  of  cancer,  which 
are  the  only  really  important  aspects  of  the 
question.  Such  inquiries  are  academically  interest- 
ing, no  doubt ;  and  all  kinds  of  knowledge,  I  freely 
admit,  mutually  illuminate  one  another.  But 
when  laboratory  results  are  obtained,  divorced,  as 
they  too  often  are,  from  every  day  life,  all  the  use 
that  can  be  made  of  them  will  be  to  corroborate  the 
conclusions  which  we  much  more  simply  and  much 
less  expensively  draw  from  the  occurrences,  from 
the  facts,  and  from  the  observations  we  may  make 
from  every  day  life.  They  can,  at  any  rate,  never, 
without  subverting  the  true  order  of  nature,  be 
made  to  supersede  the  latter.  A  striking  illustra- 
tion, I  think,  of  the  truth  of  this  view  may  be 
obtained  from  the  history  of  another  disease. 
Diphtheria  is  now  believed  to  be  caused  by  the 
growth  in  the  body  of  a  certain  micro-organism, 
the  Klebs-Loffler  bacillus.  (The  view  I  would  put 
before  the  reader  is  that  diphtheria  is  caused  not  by 
the  bacillus,  but  by  the  state  of  the  body  which 
makes  the  bacillus  flourish.)  Our  health  authori- 
ties, therefore,  following  out  logically  the  view  they 


384 

hold  as  to  the  causation  of  diphtheria,  provide 
practitioners  with  tubes,  &c.,  in  which  to  collect 
material  from  the  throats  of  patients  suffering  from 
this  disease,  and  kindly  examine  them  for  us  at  a 
public  laboratory,  free  of  charge.  They  seem  by 
their  attitude  almost  to  wish  to  compel  us  to  treat 
the  bacillus  by  injections  of  serum,  and  in  a  manner 
to  force  the  hands  of  experienced  practitioners  to 
this  mode  of  treatment,  as  if  they  thought  that  it  is 
the  disease  which  is  to  be  treated,  or  the  bacillus 
and  not  the  suffering  patient — but  I  shall  let  this 
consideration  pass.  Now  what  happens  ?  This, 
among  other  things.  The  doctor  gets  a  case,  takes 
a  swab  from  the  throat,  sends  it  to  the  laboratory, 
and,  in  due  course,  gets  a  report  that  it  swarms  with 
bacteria  of  the  most  deadly  sort.  All  the  while, 
however,  there  are  no  symptoms  in  his  patient 
which  cause  him  the  slightest  anxiety.  Then  he 
has  another  case,  or  his  colleague  has,  at  the  same 
time ;  and  on  this  case  the  report  is  that  the 
diphtheria  bacillus  is  only  doubtfully  present — yet 
the  patient  dies  in  spite  of  serum  injections  and  the 
most  approved  modes  of  treatment.  (Very  possibly 
the  patient's  blood  and  tissues  were  in  too  bad  and 
depraved  a  condition  to  allow  the  bacillus  to  grow  ? 
I  suggest,  in  fact,  that  we  have  not  yet  learned  how 
much  importance  or  how  little  we  ought  to  attach 
to  our  recent  bacteriological  discoveries).  These 
are  not  imaginary  cases ;  they  occur  every  day 
when  diphtheria  is  abundant.  What  inferences  are 
we   to    draw    from    them  ?     Why    this    inference, 


385 

among  others,  that  the  presence  or  otherwise  of  the 
diphtheria  bacillus  is  comparatively  unimportant ; 
and  that  on  the  other  hand  the  totality  of  the 
symptoms  and  the  general  condition  of  the  patient 
are  of  the  utmost  consequence.  That  is  to  say, 
that  the  laboratory  inquiries  are  not  nearly  so 
important  as  the  clinical  history  and  conditions  of 
patients,  and  that  they  must  be  corrected  by  the 
latter.  The  same  conclusions,  I  have  not  the  least 
doubt,  will  be  arrived  at  regarding  cancer ;  and 
after  the  expenditure,  not  of  a  hundred  thousand 
pounds,  but  of  a  million  pounds,  we  shall  not 
discover  anything  useful  in  the  prevention  and 
treatment  of  the  disease  in  this  way  that  we  might 
not  have  discovered  far  more  simply  from  clinical 
and  practical  observation.  For  note  ;  the  laboratory 
investigation  throws  no  light  on  the  conditions  in 
the  body  which  make  the  diphtheria  bacilli  grow  or 
fail  to  grow.  Nor  will  any  amount  of  microscopic, 
and  laboratory,  and  bacteriological  investigation 
into  cancer  be  likely  ever  to  tell  us  what  causes 
make  it  occur  in  the  body — while,  on  the  other 
hand,  a  very  little  practical  and  bed-side  investiga- 
tion gives  us  a  speedy  answer  to  the  question.  At 
least  I  think  it  does.  And  it  is  at  least  reasonable 
to  ask  inquirers  to  attempt  to  answer  the  question 
in  this  way  before  they  make  demands  for  funds, 
the  proper  application  of  which  they  have  not 
sufficiently  considered.  Some  light  on  the  question 
whether  cancer  is  accompanied  by  the  growth 
in     the     body    of    a     micro-organism     or     micro- 

Y 


386 

organisms  might  be  shed  by  this  method  of 
investigation.  And  if  the  micro-organism  proved 
to  be  always  the  same  one  in  cancer,  more  light 
might,  no  doubt,  be  obtained  as  to  the  diagnosis  of 
the  disease.  But  of  what  value  would  improved 
diagnosis  be?  Of  a  scientific  or  classification 
value,  no  doubt  it  would  be ;  but  of  practical 
value,  none,  or  next  to  none.  What  we  want 
to  know  is,  what  causes  acting  on  the  organism 
favour  the  production  of  the  diseased  state,  be 
it  connected  with  the  growth  of  micro-organisms 
or  not  ?  And  what  conditions,  on  the  other  hand, 
are  unfavourable  to  it  ?  In  short,  what  causes  it, 
and  what,  therefore,  will  prevent  it  ?  Now  these 
questions  are  physiological  and  clinical ;  and 
we  already,  I  think,  possess  all  the  knowledge  that 
we  require  to  answer  these  important  questions. 
And  to  give  an  answer  at  once  and  shortly ;  it  may 
safely  be  said  that  health  and  soundness  of  the 
body  render  it  an  unsuitable  site  for  the  growth  of 
micro-organisms,  while  unhealthiness  and  unsound- 
ness, on  the  other  hand,  render  it  suitable  for  such 
growth.  And  healthiness  and  soundness  of  body 
are  to  be  obtained  by  maintaining  proper  relations 
between  the  body  and  its  environment,  and 
particularly  by  suitable  relations  between  it  and  air, 
food,  and  exercises.  And  if,  on  the  other  hand, 
unsuitable  relations  between  the  body  and  air,  food, 
and  exercises,  have  subsisted  for  say  20,  or  25,  or 
30  years,  not  all  the  knowledge  conceivable,  or  to 
be  attained  after  the  expenditure  of  any  amount  of 


387 

time  and  labour,  and  of  any  conceivable  amount  of 
money,  into  the  natural  history  of  micro-organisms, 
will  enable  us  to  undo  the  evil  effects  of  wrong 
living  carried  on  for  so  long  a  period  of  time.  Let 
us  at  least  look  at  the  facts  presented  to  our 
clinical  observation,  of  the  habits  of  the  people  who 
suffer  from  cancer,  before  we  ask  for  money  to 
enable  us  to  institute  expensive  laboratory  in- 
quiries— let  us  use  our  eyes  before  we  inquire  with 
the  microscope — and  if,  after  that,  we  wish  to  draw 
on  the  millionaires,  or  if  they  are  willing  to  be 
drawn  upon,  by  all  means  let  them  be  invited  to 
hand  over  their  money. 

A  use  to  which  a  sum  of  a  million  pounds 
might  be  put  in  order  to  investigate  the  causes  of 
cancer  might  be  the  following.  I  fear  the  donors  of 
it  would  not  consent  to  a  use  so  simple,  but  I  have 
more  fear  for  the  demanders  than  for  the  donors. 
It  would  not  be  very  easy  to  carry  it  out  perhaps. 
What  I  would  suggest  is  that  a  large  number  of 
townspeople  at  all  ages,  say  10,000,  should  be  fed  five 
times  a  day,  say  at  eight  and  eleven  a.m.,  and  two 
five,  and  eight  p.m.,  on  bread  and  jam  for  a  genera- 
tion. Let  at  the  same  time  a  similar  number  of 
people,  similarly  circumstanced,  be  fed  twice  a  day 
only,  on  ordinary  mixed  food,  to  the  amount  of  not 
more  than  16  ounces  avoirdupois  a  day,  and  let  the 
diseases  and  illnesses  of  these  two  groups  of  people 
be  compared  and  tabulated  every  five  years  for  a 
generation.  I  know  in  which  group  the  largest 
number   of  cases   of   cancer   would   occur.     And   I 

Y  2 


388 

also  know  in  which  group  the  largest  number  of 
cases  of  other  sorts  of  disease  (yes,  including 
consumption  and  the  fevers),  would  occur.  At  the 
end  of  the  time  we  should  all  know  it  also ;  that  is, 
if  we  wished  to  know  it.  But  as  this  experiment  is 
really  being  made  all  the  time,  is  it  not  better  to 
use  our  observing  faculties  to  see  what  is  going  on, 
without  troubling  our  millionaires  to  part  with  their 
money,  or  our  caretakers  to  take  all  the  trouble  that 
would  be  involved  in  making  such  an  experiment, 
necessary  as  it  would  be  to  carry  it  on  over  a  very 
long  time  ? 

No  doubt  cancer  differs  both  from  the  fevers 
and  from  consumption  in  this  respect  that  it  claims 
its  victims  mainly  among  the  mature,  among  the 
fathers  and  mothers  of  families,  among  those  whose 
presence  has  come  to  be  most  important  to  their 
families,  and  so  to  the  community  ;  while  fever  and 
consumption  deal  with  those  whose  lives  are  yet  for 
the  most  part  in  promise,  rather  than  fulfilment. 
This  increases  the  importance  of  cancer  in  a  way 
which  the  number  of  its  victims  does  not  justify. 
It  was  no  doubt  because  he  felt  this  consideration 
weighing  upon  him  that  the  King,  on  the  25th 
July,  1901,  in  welcoming  to  London  the  Congress 
which  met  there  for  the  purpose  of  studying 
tuberculosis,  and  mitigating  its  effects,  after  some 
sympathetic  words  regarding  the  objects  of  that 
Congress,  went  on  to  say  : — 

"  There  is  still  one  other  terrible  disease  which 
has,  up  to  now,  baffled  the  scientific  and  medical 


389 

world,  and  that  is  cancer.  God  grant  that,  before 
long,  you  may  be  able  to  find  a  cure  for  it,  or  check 
its  course.  I  think  that  to  him  who  makes  the 
discovery,  a  statue  should  be  erected  in  all  the 
capitals  of  the  world." 

The  candidate  for  that  statue  is  still  to  be 
discovered,  if,  that  is,  the  finding  of  a  cure  for 
cancer  is  to  be  the  only  cause  for  which  the  statue 
is  to  be  erected.  If,  however,  checking  of  the 
course  of  cancer  is  to  be  considered  worthy  of 
the  erection  of  a  statue  in  all  the  capitals  of  the 
world,  that  is  quite  a  different  matter.  To  check 
the  course  of  cancer  would  not  be  difficult  if  the 
cause  or  causes  were  known,  for  by  obviating  its 
causes,  the  disease  could  be  prevented ;  and 
prevention  would  be  the  most  efPectual  means  of 
checking  its  course.  That  at  least  the  predisposing 
causes  of  cancer  are  known  is  a  matter  of  conviction 
with  the  writer  of  this  essay,  and  he  thinks  that 
this  conclusion  will  be  shared  by  candid  readers, 
after  consideration  of  the  evidence,  the  probable 
evidence,  which  has  weighed  with  him. 

After  what  has  been  said  already  regarding 
predisposing  and  exciting  causes,  and  the  differences 
between  them,  I  need  not  weary  the  reader  by 
recapitulation.  As  it  is  the  predisposing  causes 
which  are  important,  it  is  to  them  that  our 
attention  must  be  directed.  The  suggestion  is  that 
by  acting  in  certain  directions,  which  are  easily 
within  our  own  power  and  control,  we  might  be  able 
to  prevent  the  incidence  of  a  large  proportion   of 


390 

the  cancer  which  now  afflicts  us.  Cure  of  cancer, 
after  it  has  once  occurred  in  the  body,  is  a  very- 
different  affair  from  prevention.  Prevention  may 
be  easy  ;  cure  impossible,  or  practically  impossible. 
These  are,  in  fact,  the  conclusions  which  I  wish  to 
set  before  the  reader. 

A  preliminary  word  may,  however,  be  permissible 
regarding  prevention,  in  general,  of  cancer,  and  of 
other  diseases.  However  well  the  causes  of  disease 
may  be  known,  and  however  well  we  may  grapple 
with  them,  or  strive  to  prevent  their  action,  it  is 
scarcely  to  be  hoped  that  we  shall  ever  absolutely 
prevent  the  occurrence  of  their  effects.  The 
complete  prevention  of  cancer  is  not  to  be  looked 
for.  There  will  always  be  anomalies  for  which  we 
shall  be  unable  to  account,  always  some  cases  which 
it  will  be  impossible  to  avoid.  Some  unknown  and 
probably  undiscoverable  causes  in  the  history  of 
various  individuals,  or  in  their  ancestry,  some 
instances  of  the  unknown  "  personal  equation  "  will 
arise,  which  will  make  it  impossible  for  us  to 
prevent  occasional  cases  of  this  disease.  Cancer 
does  not  differ  from  other  diseases  in  this  respect. 
The  fevers,  for  example,  and  consumption  are  held 
to  be  preventible  diseases ;  but  they  have  not  been 
prevented,  although  their  incidence  and  mortality 
have  been  considerably  diminished  ;  and  although  I 
think  that  much  more  might  be  done  in  this 
direction  than  has  yet  taken  place,  if  we  were 
somewhat  to  enlarge  our  conception  of  the 
causation  of  these  diseases  beyond  the  view  which 


391 

attributes  them  to  bad  air  and  over-crowding,  still 
I  do  not  expect  that  we  shall  ever  entirely  put  an 
end  to  either  of  these  plagues  of  humanity. 
Already  consumption  has  fallen  as  a  cause  of 
mortality  from  2800  per  million  per  annum,  at 
which  point  it  stood  at  the  time  of  the  Crimean 
war,  to  1325  per  million  ;  and  no  doubt  it  will  fall 
still  further,  but  it  will  be  Utopian  to  expect  that  it 
will  ever  entirely  cease  from  among  us.  Some 
cases,  I  suppose,  always  will  occur,  as  they  always 
have  occurred  in  the  past,  in  the  long  history  of  the 
relations  between  the  organism  and  its  enviroment, 
for  it  is  improbable  that  even  if  we  knew  quite  all 
the  causes  of  our  illnesses,  we  should  ever  be  able 
to  entirely  obviate  their  action  or  neutralise  their 
effects.  The  same  considerations  must  govern  us  in 
the  case  of  cancer.  A  diminution  by  one  half 
would  be  a  great  achievement.  A  reduction  by  75 
or  80  per  cent,  might,  almost  without  straining  of 
language,  be  called  practical  prevention.  In  the 
decennium,  1861-70,  there  died  of  cancer  in 
England  and  Wales  a  proportion  of  people  amount- 
ing to  384  per  million  per  annum  persons  living.  In 
1871-80  the  proportion  had  risen  to  468  per  million 
per  annum.  In  1881-90  the  number  was  589,  and 
the  ratio  is  still  rising.  In  the  five  years,  1891-5, 
the  ratio,  for  instance,  was  712,  and  in  the  four 
years,  1896-9,  the  latest  date  for  which  figures  are 
available,  it  has  risen  to  795,  an  increase  of  more 
than  double,  if  we  compare  it  with  1861-70.  It  is 
not  necessary  here  to  consider  the  question  whether 


392 

the  whole  of  this  great  and  alarming  rise  is  real,  or 
whether  it  is  only  partially  so.  Allowing  for 
whatever  part  of  the  increase  can  be  accounted  for 
by  better  diagnostic  power  and  better  naming  of 
diseases,  it  still  does  not  seem  possible  to  escape  the 
conclusion  that  this  disease  has  increased  steadily 
as  a  cause  of  death  for  the  last  forty  years.  Now 
while  the  writer  does  not  look  for  anything  like 
complete  prevention,  he  does  not  see  any  reason 
why  it  should  not  be  reduced  again  to  the  rate  at 
which  it  stood  say  in  1861-5  (368  per  million  per 
annum),  or  even  why  it  might  not  be  reduced  still 
further  than  the  rate  then  obtaining. 

The  first  question,  then,  which  we  have  to 
discuss,  is  this :  Is  the  discovery  of  a  cure  for 
cancer  an  object  likely  to  be  achieved,  a  goal 
possible  of  attainment  ?  To  the  question  put  in 
this  form  the  writer's  answer  is  negative.  The 
search  for  the  cure  or  for  a  cure  for  cancer  is  not  a 
hopeful  role  to  follow.  It  is  in  fact  an  object 
impossible  of  attainment,  or  at  least  so  unlikely  to 
be  attained  as  to  render  the  search  for  its  attain- 
ment futile.  We  may  as  well  spare  our  pains. 
The  writer's  view  is  that  when  cancer  has  set  in, 
when  the  body  physical  has  become  cancerous  or 
affected  with  cancer,  the  organism  has  become  so 
profoundly  modified  in  an  unhealthy  direction  that 
to  hope  or  work  for  cure  is  to  hope  or  work  for  that 
whose  attainment  is  impossible.  Perhaps  he  ought 
not  to  use  the  word  impossible.  It  is  not  necessary 
to  contend  that  no  case  of  cancer  has  ever  been 


393 

cured.  That  would  be  to  go  beyond  the  evidence. 
Occasionally,  though  very  rarely  indeed,  probably 
persons  affected  with  cancer  have  been  cured,  or  at 
least  have  recovered.  But  the  view  of  the  writer 
is  that  cancer  has  been  so  rarely  cured  that  it  is  far 
nearer  the  truth  to  say  of  the  organism — once 
cancerous  always  cancerous — than  to  say  that  it  is 
likely  to  be  helpful  or  profitable  for  us  to  embark 
on  a  voyage  of  discovery  to  obtain  a  cure  for  this 
disease.  Instead  of  impossible  the  writer  would 
prefer  the  expression  practically  unattainable. 
Impossible  raises  metaphysical  or  super-sensible  or 
ultra-scientific  considerations  (which  considerations, 
however,  we  cannot  help  raising  from  time  to  time, 
however  difficult  their  solution  may  be),  and  these 
would  be  shewn  to  be  inadmissible  if  but  one  case 
of  cancer  had  been  proved  to  be  cured — a  possibility 
which,  as  he  says,  the  writer  is  not  concerned  to 
deny.  It  is  not  what  is  abstractly  possible  that 
will  profitably  occupy  our  attention  and  our  efforts, 
but  what  is  likely  to  be  practically  attainable  in  the 
light  of  our  knowledge  of  causes,  and  of  that  which 
has  hitherto  been  attained.  The  writer's  view  is 
that  "  once  cancerous  always  cancerous "  is  a 
position  of  mind  and  fact  far  nearer  the  truth 
than  that  the  discovery  of  a  cure  for  cancer  is 
likely  to  be  made.  Certainly  if  operation  is  to  be 
persisted  in  for  the  eradication  or  obviation  of  the 
effects  of  this  malady,  some  addition  will  have  to 
be  made  to  this  method  of  dealing  with  it,  some 
advice   concurrently  given  which   shall  enable  the 


394 

patient  to  get  outside  of  the  action  of  those  causes 
which  have  induced  the  disease  in  the  first  instance, 
and  whose  obviation  may  enable  him  to  prevent  the 
recurrence,  which,  though  sometimes  delayed  for 
many  years,  and  very  rarely,  perhaps,  obviated 
altogether,  takes  place  in  the  large  majority  of 
cases  in  from  six  months  to  four  years.  If 
operation  alone  is  more  or  less  futile  in  curing 
cancer,  perhaps  operation  coupled  with  the  advice 
to  live  differently  in  future  might  have  some  chance 
of  effecting  a  cure  ?  When  His  Most  Gracious 
Majesty  made  to  the  scientific  men  assembled  in  his 
capital  the  suggestion  referred  to,  he  no  doubt 
spoke  out  of  a  full  heart,  which  was  still  lamenting 
the  death  of  a  younger  brother  from  that  disease, 
and  at  the  same  time  was  looking  hopelessly 
forward  to  the  certainty,  which  has  been  unfor- 
tunately too  sadly  realised,  that  an  elder  sister  was 
about  to  succumb  to  the  same  malady.  Without 
discussing  what  is  theoretically  possible,  the 
experience  of  the  royal  families  of  England  and 
Germany  emphasises  the  futility  of  the  treatment 
of  cancer  in  the  present  state  of  knowledge,  for  if 
these  powerful  families  could  not  command  the 
means  of  cure,  it  may  well  be  asked — who  could  ? 
In  the  writer's  view,  the  causes  of  failure  to  find  a 
cure  were  and  are  inherent  in  the  nature  of  the 
case,  and  the  fact  that  the  best  skill  available, 
medical  and  surgical,  failed  to  save  the  patients, 
was  no  accident  of  the  situation,  but  an  ultimate 
factor   to   be    dealt    with    in    at    least    the    great 


395 

majority  of  cases  where  changes  have  advanced 
so  far  in  the  organism  as  to  result  in  the  formation 
of  the  cancerous  state.  It  will  be  seen,  therefore, 
that,  for  reasons  which  he  believes  will  strengthen 
as  his  argument  proceeds,  the  writer  thinks  that 
the  search  for  a  cure  for  cancer  is  not  a  hopeful 
object  of  research ;  and,  in  fact,  he  believes  it  to  be 
practically  impossible  of  attainment.  He  is  no 
candidate  for  the  statue  to  be  erected  in  all  the 
capitals  of  the  world.  If  through  a  flaw  in  the 
bank  of  a  great  reservoir  the  confined  waters  had 
burst  their  bonds,  had  devastated  the  neighbouring 
country,  had  destroyed  growing  crops,  had  drowned 
cattle,  swept  away  houses,  and  carried  to  long 
distances  the  corpses  of  their  occupants,  it  would 
be  obviously  futile  to  suggest  the  erecting  of  a 
statue  to  whosoever  should  cure  the  efiects  of  the 
devastation,  since  indeed  the  effects  would  be 
incurable.  Nothing  ever  would  or  could  restore 
the  crops,  the  houses,  the  cattle,  or  the  men.  But 
it  would  be  hopeful — and  if  the  erection  of  a  statue 
in  all  the  capitals  were  considered  a  fit  reward  for 
the  service,  the  candidate  for  the  statue  might 
easily  be  forthcoming — it  would  be  hopeful  to 
mquire  how  the  devastation  occurred,  where  the 
flaws  in  the  banks  were,  and  by  repairing  and 
strengthening  the  weak  place  or  places,  to  prevent 
a  recurrence  of  the  evil  whose  effects  unfortunately 
it  would  be  too  late  to  remove  or  undo.  Especially 
would  this  be  so  if  not  one  but  several  devastations 
had    successively   occurred,    for    no    donbt    proper 


396 

arrangements  would  prevent  such  recurrences  in  the 
future.  The  parallel  between  the  effects  of  such  a 
devastation,  or  such  a  succession  of  devastations, 
and  the  ravages  of  cancer,  appears  to  the  writer  to 
be  very  complete.  To  cure  it  appears  to  him 
almost  as  hopeless  as  to  attempt  to  undo  the  effects 
of  the  devastation.  The  proper  aim  and  role  of 
medicine  is  not  to  attempt  to  undo  effects  without 
reference  to  causes,  although  unfortunately  we  too 
often  act  as  if  we  thought  it  was.  Her  true  role 
really  is,  by  discovering  the  causes  of  the  maladies 
from  which  we  suffer,  to  prevent  the  effects  by 
removing  the  organism  outside  of  the  sphere  of 
action  of  the  causes.  In  fact,  the  enlargement  of 
the  sphere  of  preventive  medicine  is  a  much  more 
hopeful  object  of  attainment  to  true  medical  science 
than  the  discovery  of  cures.  Cures  are  effected  by 
nature,  and  the  chief  function  of  the  medical 
adviser  is  to  interfere  as  little  as  possible  with  the 
beneficent  means  of  cure  adopted  by  nature. 

By  cancer,  the  writer  means  chiefly  carcinoma 
or  epithelioma,  an  overgrowth  of  epithelial  or 
superficial  structures,  two  or  more  epithelial  cells 
appearing  instead  of  one.  This  condition,  when 
once  it  has  commenced,  goes  on  to  more  and  more, 
constantly  spreading,  ulcerating,  or  fungating  by 
advance  and  recession,  the  advance,  however, 
unfortunately  preponderating,  till  in  time  the 
disease  destroys  the  life  of  the  person  suffering 
from  it.  As  to  sarcoma,  as  distinguished  from 
carcinoma,    the    most     illuminating    idea,     in     my 


397 

opinion,  is  the  view  that  sarcoma  is  merely  cancer  of 
the  connective  tissue.  This  idea  simplifies  the 
problem  very  much,  since  on  this  view  cancer  of 
epithelium  is  a  special  form  of  hypertrophy  of 
the  epithelial  tissues,  and  sarcoma  is  cancer  of 
connective  tissue.  So  that  cancer  and  sarcoma 
are  probably  both  due  to  the  action  of  the  same 
causes  on  different  tissues ;  and  the  investigation  or 
study  of  the  one  is  the  same,  mutatis  mutandis,  as 
the  investigation  or  study  of  the  other.  But  to  call 
carcinoma  or  sarcoma  a  hypertrophy  or  overgrowth 
is  to  endorse  the  writer's  view  that  they  are  an 
overgrowth  due  to  over-nutrition.  And  no  doubt 
cancer  and  sarcoma  are  hypertrophies  or  over- 
growths. In  the  one  case  there  is  a  large  increase 
in  the  amount  and  number  of  the  epithelial  cells, 
the  appearance  of  two  or  more  epithelial  cells 
where  only  only  one  ought  normally  to  be ;  in  the 
other  case  there  is  a  large  increase  in  the  number  of 
connective  tissue  corpuscles.  Perhaps,  on  the 
same  lines,  colloid  cancer  might  be  considered  a 
h3rpertrophy  of  the  mucoid  cells,  and  encephaloid 
cancer  of  some  other  forms  of  cells  ?  Parasitic  cells 
might  or  might  not  appear  among  these  cells, 
according  as  it  happened.  But  the  essence  of  the 
disease  on  this  view  is  the  hypertrophy ;  the 
occurrence  of  parasites  the  accident.  Now  the 
question  is,  what  is  the  chief  predisposing  cause  of 
overgrowth?  Well,  what  can  be  the  cause  except 
an  excess  of  materials  in  the  blood  ?  And  if  so, 
whence  came  the  excess  of  material  which  is  poured 


398 

out  of  the  blood  in  the  form  of  the  cancerous 
exudation  ?  What  source  can  there  be  but  the 
environment  of  the  organism  ?  And  of  all  the 
facts  of  environment,  what  so  likely  to  be  the  chief 
cause  of  change  in  the  body  as  the  food  ? 

A  recent  writer  on  cancer,  in  advocating  the 
infection  theory  from  without,  says  that  "no 
alleged  cause  can  possibly  be  accepted  which  is  not 
universally  applicable,  and  infection  from  without  is 
the  only  suggested  cause  which  will  satisfactorily 
account  for  every  case  of  cancer."  Well,  this  is  not 
incompatible  with  my  view  that  over-feeding  is  the 
predisposing  cause  of  cancer,  because  it  is  even  more 
' '  universally  applicable  "  than  infection,  and  because 
the  over-fed  state  of  the  organism  is  an  efficient 
cause  in  making  infectious  diseases  grow  in  the 
body  as  noxious  weeds  grow  in  the  soil,  from  over- 
manuring  of  the  ground ;  and  certainly  over- 
feeding is  introduced  "from  without." 

As  regards  sarcoma  and  the  view  that  it  is  a 
connective-tissue-cancer,  how  illuminating  and  how 
important  become  the  remarks  formerly  made,  that 
this  same  connective  tissue  is  the  first  great  place 
or  part  in  the  body  where  the  products  of  an  excess 
of  food  materials,  finding  their  way  into  the  blood, 
are  primarily  deposited.  We  called  the  connective 
tissue  the  great  dumping  ground  of  the  blood,  the 
place  which  was,  so  to  say,  chosen  by  the  blood 
as  the  least  hurtful  place  or  site  in  which  to  lay 
down  any  excess  of  material  which  it  might  be 
carrying,  and  for  which  it  had  no  use.     Under  the 


399 

name  of  initis,  we  shewed  how  connective-tissue- 
congestion  was  the  basis  of  such  states  as  neurosis, 
hysteria,  rheumatism,  gout,  &c.  And  we  further 
shewed  that  the  next  stage  after  initic  congestion 
was  effusion,  as  e.g.,  into  joints,  or  into  the 
origins,  or  insertions  of  tendons  about  joints,  or  into 
such  cavities  as  the  pleura  or  peritoneum,  or  the 
membranes  or  meninges  of  the  brain.  Now  we  see 
that  when  connective-tissue-h3rpertrophy  or  over- 
growth takes  place  in  any  particular  part  of 
the  body,  sarcoma  may  occur,  and  from  these 
facts  becomes  more  apparent  the  connection 
between  diseases  so  very  different  (at  first  sight) 
from  one  another  as  sarcoma  and  the  diseases  just 
named.  From  which  considerations  a  corroboration 
arises  of  the  view  that  disease  is  essentially  one, 
with  many  different  phases  or  aspects,  a  view  which 
has  been  held  in  the  past  by  some  of  the  greatest 
thinkers  and  writers  on  medicine  Changes  in 
connective-tissue-cells  form  the  one  common  factor 
uniting  these  so  various  diseased  states ;  and 
changes  of  this  sort  are  brought  about  by  changes 
in  nutrition,  that  is,  in  the  feeding  of  the  body.  It 
is  food  supply,  therefore,  which  is  the  chief  factor 
in  inducing  health  or  disease  in  the  body,  and  to 
alterations  in  this  (and  usually  to  restrictions)  must 
we  look  if  we  are  to  do  anything  towards  relief  of 
the  fatigue  that  accompanies  initis,  or  towards 
the  prevention  or  diminution  of  the  hypertrophy 
that  characterises  sarcoma  and  epithelioma. 

It  may  be  well  to  inquire  here,    since  cancer 


400 

and  sarcoma  seem  to  be  made  out  of  an  excess 
of  material  finding  its  way  into  the  blood,  what  are 
the  chief  ways  by  which  such  a  process  is  likely  to 
occur,  how,  in  fact,  any  excess  of  material  or, 
indeed,  how  any  material  at  all  may  find  its  way 
into  the  blood.  There  seem  to  be  three  or  perhaps 
four  channels  through  which  such  entrance  may  be 
efi*ected.  (a)  Foreign  matter  may  enter  the 
economy  through  the  respiration ;  it  may  be 
inhaled  or  breathed  in.  (b)  It  may  be  inoculated, 
or  it  may  find  its  way  in  through  some  crack  in  the 
skin,  or  in  a  mucous  surface,  (c)  It  may  be 
introduced  through  the  ancestors,  (d)  It  may 
enter  through  the  mouth ;  it  may  be  swallowed 
with  food  or  drink  ;  or,  an  excess  of  food,  being 
ingested  into  the  digestive  tract,  may  cause  some 
form  of  disease,  and  may  require  to  be  eliminated 
in  some  way.  To  take  these  different  methods  in 
order,  shortly,  let  us  inquire,  is  it  likely  that  cancer 
is  breathed  or  inhaled  into  the  system  ?  Is  it 
likely  that  some  germ,  for  instance,  lighting  upon 
our  clothes,  may  be  inhaled  as  impalpable  dust,  and 
do  its  deadly  work  after  its  reception  into  the 
economy  ?  This  is  a  possible  mode  of  the 
introduction,  no  doubt.  There  are  other  affections 
whose  introduction  into  the  economy  is  believed  to 
be,  at  least  sometimes,  effected  in  this  way ; 
whooping  cough,  for  example,  consumjDtion,  and 
others.  But  is  it  likely  that  carcinoma  is  intro- 
duced in  this  way  ?  The  writer  thinks  not. 
Affections   so    introduced,    or    rather,    bodily    con- 


401 

ditions  so  induced  (for  disease  is  not  so  much  an 
entity  superinduced  on  the  body,  or  added  to  it,  as 
a  state  of  body  somehow  induced,  a  departure  from 
health),  generally  run  a  rapid  course,  extending 
over  a  few  days  or  weeks,  and  accompanied  by 
notable  feverishness.  Neither  of  these  facts  is 
characteristic  of  cancer,  whose  onset  is  usually 
insidious,  and  its  course  slow  and  unaccompanied  by 
feverishness.  In  fact,  so  far  from  the  temperature 
being  raised  in  cancer,  it  is  usually  sub-normal  for 
years  before  the  onset  of  carcinoma,  only  rising 
above  normal  as  intercurrent  inflammatory  attacks 
occur.  And  the  temperature  appears  to  be  sub- 
normal, because  the  presence  of  the  effete  materials 
in  the  blood  and  tissues,  which  induce  the  diseased 
condition,  lower  vitality  and  crush  down  the 
powers  of  the  organism,  like  a  horse  overburdened 
under  the  load  which  it  is  carrying.  Another 
objection,  not  of  great  weight,  perhaps,  in  itself, 
but  helping  as  a  contributory  consideration  to 
induce  a  negative  answer  to  the  question  whether 
cancer  is  introduced  through  the  respiration 
is,  that  if  it  were  so  introduced,  we  should 
expect  cancer  to  affect  the  respiratory  tract 
more  than  it  does.  But  although  cancer  does 
affect  the  lungs  sometimes,  it  does  so  far  too 
seldom  to  make  it  seem  probable  that  the  diseased 
condition  is  produced  in  this  way.  Even  if  it  does, 
however,  or  if  it  did,  all  the  considerations  formerly 
noticed  regarding  the  mutual  relations  or  reciprocity 
of  soil  and  seed  would  still  remain  and  hold  good ; 
z 


402 

so  that  as  regards  prevention  of  such  a  possible 
mode  of  infection,  the  measures  proposed  would  bear 
relation  chiefly  to  the  germ  on  the  one  hand,  or 
chiefly  to  the  state  of  the  person  on  the  other, 
according  to  the  importance  one  attached  to 
either  of  these  factors.  On  the  one  view,  we 
should  advise  the  person  to  avoid  and  keep 
clear  of  infection ;  on  the  other,  to  get  his  body 
into  such  a  state  that  if  a  cancer  germ  or  two  did 
light  on  him,  he  would  take  no  harm  from  it.  It 
will,  I  hope,  now  be  abundantly  evident  which  of 
these  two  views  I  should  take.. 

(b)  Is  it  likely  next  that  cancer  is  introduced 
into  the  economy,  or  that  the  economy  becomes 
cancerous  by  inoculation  through  a  crack  in  the 
skin,  or  by  endosmosis  or  absorption  through  the 
skin  or  other  bodily  surface  ?  If  so,  should  we  not 
be  able  to  point  to  the  spot  at  which  the  inoculation 
was  effected,  and  to  prove  the  onset  of  the  disease 
in  this  manner,  as  also  to  detail  its  further 
progress  ?  The  evidence  that  cancer  is  introducible 
in  this  way  will  be  dealt  with  immediately.  At 
present  all  that  need  be  said  is  that  it  is  not  a 
very  likely  mode  of  cancer  origin,  although  it 
certainly  cannot  be  pronounced  to  be  an  impossible 
one. 

It  may  appear  to  some  that  lip  cancer,  or 
epithelioma  of  the  lip,  so  frequently  associated 
with  the  smoking  habit,  that  it  is  rare  indeed  to 
find  it  in  non-smokers  (I  have  only  once  seen  it  in 
a  woman,  and  she  smoked)  afibrds  a  case  in  point, 


403 

where  the  cancerous  germ  is  or  may  be  introduced 
into  the  blood,  through  a  crack  in  the  lip.  But 
another  explanation  is  possible,  and  quite  as 
reasonable,  if  not  more  so,  viz.,  that  the  smoking 
acts  only  as  an  irritant  to  the  lip,  the  excess  of 
activity  thereby  induced  to  the  part  causing  an 
increased  flow  of  blood  thereto,  the  blood  depositing 
therefore  at  that  spot  by  preference  some  of  the 
waste  or  unused  material  which  it  had  in  it  in 
excess,  so  forming  the  .epitheliomatous  growth. 
There  is  no  evidence  that  the  tobacco  introduced 
the  particulate  matter  which  caused  the  epithelioma, 
any  more  than  that  the  basic  slag  formerly  referred 
to  introduced  the  clover  seed,  or  that  the  railway 
cutting  introduced  the  seeds  of  the  new  flora,  after- 
wards found  in  the  district.  It  is,  however,  quite 
reasonable  to  suggest,  and,  I  may  add,  it  is  a 
sufficient  explanation,  that  the  irritation,  by 
heightening  vascular  activity,  acted  in  the  way 
supposed.  There  are  numerous  other  analogies 
to  bear  out  this  view.  For  instance,  the 
occurrence  of  cancer  is  often  attributed  to  a 
blow  ;  but  no  one  suggests  that,  for  example,  a 
blow  from  a  child's  arm,  causing  cancer  in  the 
mother's  breast,  actually  introduced  a  cancer  germ 
at  the  time.  Such  a  thing  is  highly  improbable, 
and  indeed  practically  impossible.  Then  again, 
take  this  case  which  actually  occurred  in  my 
experience.  An  old  gentleman  of  87  years  of  age, 
was  knocked  down  by  a  bicycle,  and  the  injury  was 
followed    by    an    attack    of    gout.     The    obvious 

22 


404 

explanation  of  both  of  these  cases  (and  It  is  quite 
a  sufficient  one),  is  that  the  blow  followed  by- 
cancer,  and  the  bicycle  injury  followed  by  gout, 
were  in  both  cases  the  occasion  indeed  of  the 
malady,  but  they  were  not  the  cause  (7r/oo<I>ao-t9  ovk 
aiTLa,  to  use  the  words  of  Hippocrates),  the  cause 
being  the  state  of  the  patient's  blood  in  both  cases, 
loaded  as  it  no  doubt  was  by  the  presence  of  waste 
unassimilated  materials.  Otherwise  we  may  say 
the  injury  was  no  doubt  part  of  the  cause,  but  only 
a  small  part,  the  chief  part  being  the  state  of  the 
patient's  blood  and  tissues. 

I  ought,  however,  to  discuss  another  phase  of 
this  question  before  leaving  it.  Experimental 
inoculation  of  cancer  appears  to  have  been  success- 
fully performed  in  the  lower  animals.  Watery 
emulsions  of  materials  taken  from  cancerous 
growths,  on  being  injected  into  the  veins  of  dogs, 
have  been  followed  in  course  of  time  by  the  appear- 
ance of  cancerous  growths  in  the  lungs.  Well,  I  can 
admit  the  success  of  these  and  similar  experiments 
without  any  damage  to  my  theory  that  over-feeding 
is  the  chief  predisposing  cause  of  cancer,  because  I 
do  not  deny  that,  after  cancer  has  been  produced  in 
the  body,  it  may  spread  by  infection  from  a  given 
site.  But  I  wish  to  point  out  that  cancer  in  fact 
never  does  come  in  the  human  subject  from 
inoculation,  except  in  one  or  two  very  rare  and  not 
quite  certain  cases,  in  which  surgeons  may  have 
inoculated  themselves.  I  must  say  that  such  a  risk 
in  operating  troubles  me  very  little.     I  should  think 


405 

that  the  state  of  the  operator's  health  had  more  to 
do  with  such  a  mode  of  origin  than  the  inoculation 
which  was  alleged  to  cause  it.  And,  besides,  our 
problem  is  to  account  for  the  original  origin  oP 
cancer  and  sarcoma,  rather  than  to  say  how  it  may- 
behave  and  how  it  may  infect  the  body  after  it  has 
begun  to  grow. 

(c)  Has  carcinoma  been  transmitted  from 
ancestors  ?  Is  it  being  so  transmitted  now  ?  Is  it 
a  hereditary  disease  ?  If  this  were  so,  should  we 
not  find  cancer  running  in  families  more  than  we 
do  ?  And  should  we  not  also  find  cancer  appearing 
oftener  than  we  do  in  the  childhood  of  the  children 
of  those  who  have  themselves  suffered  from  the 
disease  ?  But  there  is  no  evidence  of  this.  Even 
if  it  were  so  (and  I  have  already  discussed  this 
question  in  dealing  with  the  general  subject  of 
the  heredity  of  disease)  and  if  the  children  of 
persons  suffering  from  cancer  were  themselves 
cancerous,  it  would  not  follow  that  the  disease  was 
transmitted,  because  it  might  have  been,  and 
probably,  in  fact,  would  have  been  the  similarity  of 
environment  in  parent  and  children,  the  similarity  of 
the  conditions  to  which  both  were  subjected,  which 
induced  the  affection  in  all  the  cases.  Where, 
however,  is  the  proof  of  the  hereditary  transmission 
of  carcinoma,  when  in  so  many  cases  grown  up 
descendants  die  of  quite  different  affections  ?  of 
pneumonia,  for  example,  of  infectious  fevers,  or  in 
advanced  life  ?  I  need  not  repeat  what  I  said 
before  in  dealing  with  the  general  question.     I  wiU 


406 

just  remind  the  reader  that  the  occurrence  of  cancer 
in  childhood  is  very  rare  indeed,  while  we  should 
expect  it  to  be  common  in  childhood  if  it  were 
hereditarily  transmitted,  since  young  children  are 
nearer  to  their  parents  than  they  are  later,  and  may 
therefore  be  expected  to  be  more  affected  than 
afterwards  by  inherited  conditions.  But  if  cancer 
appears  after  50  years  of  age  in  the  descendants  of 
those  persons  who  may  have  suffered  from  cancer, 
we  shall  have  to  answer  to  ourselves  this  question  : 
whether  is  it  more  likely  that  a  disease,  appearing 
after  half  a  century  of  life,  or  more,  has  been 
transmitted  from  ancestors ;  or,  is  it  more  likely 
that  it  has  been  acquired,  that  is,  produced 
by  some  condition  in  the  environment  of  the 
persons  who  suffered  from  it  ?  By  some  habits  of 
their  own,  in  fact  ?  Put  in  this  way,  there  can  be 
but  one  answer  to  the  question,  viz.  :  it  is  far  more 
likely  that  it  has  been  acquired.  In  the  case  again 
of  parents  suffering  from  cancer,  and  whose  children 
may  also  suffer  from  the  disease,  other  con- 
siderations arise.  In  many  instances  the  parents 
did  not  acquire  the  disease  till  long  after  the  birth 
of  their  children.  Children  may  be  born  when 
their  parents  are  35  or  40  years  of  age,  and  when 
the  parents  were  quite  healthy,  so  far  as  could  be 
known.  But  at  55  or  60  years  of  age,  when  the 
children  were  20  years  old,  or  so,  the  parents,  let  us 
suppose,  develope  cancer.  Is  it  likely  that  in  such 
circumstances  parents  will  transmit  to  their  offspring 
an  affection  which  they  did  not  themselves   suffer 


407 

from  for  20  years  after  their  children  were  born? 
There  is  surely  no  evidence  for  this,  on  the  face  of 
it,  unlikely  view.  It  will  be  said,  they  transmitted, 
not  the  disease,  but  the  predisposition  to  it.  But 
what  is  the  meaning  of  predisposition  ?  Pre- 
disposition means  inverse  resistance ;  it  means  that 
the  children  in  such  circumstances  took  on  cancer 
more  readily  than  other  and  ordinary  children 
would  have  done.  But  the  proof  of  this  is  very 
hazy  and  very  vague.  The  theory  is  started  to 
account  for  a  set  of  facts,  of  which  a  far  more 
likely  explanation  is  at  hand,  viz.  :  that  similar 
conditions  of  environment  induced  the  diseased 
conditions  in  the  parents,  and  many  years  after- 
wards in  the  children.  The  ancestors  were  not  to 
blame.  They  transmitted  to  their  children  the 
same  sound  constitution  which  they  themselves 
possessed  at  the  time  of  the  birth  of  their  children. 
They  did  not  then  suffer  from  cancer.  How  could 
they  then  transmit  that  which  they  did  not 
themselves  have  or  possess  ?  Obviously  this  phase 
of  the  question  only  requires  to  be  stated  in  order 
to  be  answered  in  the  negative. 

But  further.  If  parents  suffer  from  cancer  at 
the  time  of  the  birth  of  their  children,  and  if  the 
children  suffer  in  turn  from  cancer,  but  not  till  after 
they  are  50  years  of  age,  is  there  any  proof  of  the 
transmission  of  cancer  in  this  case  ?  Very  little. 
Organisation  is  transmitted,  indeed,  and  any  human 
being  may  take  on  any  human  condition  or  disease, 
as   every   human    being    is    predisposed   to   every 


408 

human  ailment ;  but  as  to  the  Inheritance  of  disease, 
what  is  the  proof  or  evidence  for  that  ?  Sometimes, 
indeed,  though  very  rarely,  disease  does  seem  to  be 
transmitted,  as  when  a  family-disease  appears  in 
the  children  at  birth,  or  immediately  after  it,  and 
before  the  causes  which  generally  induce  it  have 
had  time  to  act  and  to  bring  it  on.  But  how  rarely 
does  this  occur.  No  doubt  when  it  does  happen,  it 
is  a  very  striking  fact,  and  one  which  makes  a  deep 
impression  on  our  minds.  As,  however,  I  have 
already  dealt  with  the  general  question  of  the 
hereditary  transmission  of  disease  in  the  chapter  on 
heredity,  I  will  not  go  further  into  it  now, 
contenting  myself  with  the  statement  of  my  two  or 
three  contentions,  (l)  that  although  disease  seems 
sometimes  to  be  transmitted  from  ancestors  to 
offspring,  this  very  rarely  happens  ;  (2)  that  as  a 
rule  organisation  is  transmitted  and  disease  not ; 
and  (3)  that  the  chief  law  of  heredity  in  disease 
(and  in  cancer,  therefore,  as  a  form  of  disease),  is 
this  :  that  like  causes  acting  on  like  organisms  in 
succeeding  generations  induce  like  effects. 

To  see  now  as  an  actual  fact  what  probability 
there  is  of  cancer  being  transmitted  or  inherited, 
let  us  consider  the  following  statements.  Of  the 
20,358  persons  who  died  of  cancer  in  England  and 
Wales  in  1892,  only  103  were  under  five  years  of 
age.  Of  the  21,135  who  died  of  this  disease  in 
1893,  only  94  were  under  five  years  of  age.  Of  the 
21,442  persons  who  died  of  it  in  1894,  only  103 
were  under  five  years  of  age  ;  while  of  the  22,945 


409 

who  died  in  1895,  and  of  the  23,521  who  succumbed 
in  1896,  only  115  and  110  respectively  were  under 
the  age  of  five  years.  That  is  to  say,  out  of  the 
109,396  persons  who  died  in  England  and  Wales  of 
cancer  in  the  quinquennium  of  1892-6,  only  525  or 
•48  per  cent.,  not  quite  one  in  two  hundred,  were 
under  five  years  of  age.  Surely  if  cancer  were  a 
hereditary  aflection,  a  larger  proportion  than  this 
of  cases  of  the  disease  would  have  occurred  in  early 
life,  since  children,  being  nearer  to  their  parents 
than  they  become  later  in  life,  would  be  more  likely 
to  manifest  congenital  characteristics.  If,  however, 
the  causes  inducing  cancer  take  some  time  to  act, 
and  if  the  affection  is  acquired  and  not  hereditary, 
we  can  see  how  it  should  become,  as  in  fact  it  does, 
increasingly  fatal  as  age  advances,  that  is,  in  pro- 
portion as  the  causes  which  induce  it  have  longer 
and  longer  time  to  act.  If,  then,  it  does  not  seem 
very  likely  that  cancer  is  inhaled  into  the  economy 
by  the  entrance  of  some  germ  through  the 
respiratory  tract ;  if  there  does  not  seem  much 
likelihood  that  it  enters  the  body  by  being  absorbed 
through  the  skin ;  or  if  the  fact  that  so  few  cases 
occur  in  infancy  discredits  the  theory  of  its 
hereditary  transmission,  are  there  any  other 
suppositions  open  to  us  ?  Seemingly,  the  causes  of 
cancer,  whatever  they  are,  take  time  to  act.  As 
has  been  said,  deaths  from  cancer  are  increasingly 
numerous  as  age  advances.  In  1900,  for  instance, 
which  shewed  the  same  characteristics  as  are  seen 
in  other  years,  there  were   only   502    deaths   from 


410 

cancer  under  25  years  of  age  out  of  the  26,721 
deaths  from  cancer  in  that  year.  From  25-35  years 
of  age,  737  deaths  occurred.  Between  35  and  45 
years  of  age,  2551  deaths  occun'ed  from  cancer  ; 
between  45  and  55,  5501  deaths  occurred  from 
cancer;  between  55  and  65,  7745  deaths  occurred; 
and  between  65  and  75,  6631  deaths  occurred. 
That  is  to  say,  the  causes  of  cancer,  whatever  they 
are,  increase  as  Hfe  advances,  reaching  their 
culmination  in  the  middle  period  of  life  after  45 
years  of  age,  and  between  that  time  and  75. 

[d)  The  fact  that  (practically)  cancer  is  not  a 
children's  disease  has  insensibly  brought  the  inquiry 
up  to  the  fourth  way  in  which  foreign  material 
may  find  its  way  into  the  blood,  viz.,  through  the 
digestion.  Does  cancer  enter  the  system  through 
the  digestion  ?  The  facts  regarding  the  age- 
incidence  of  cancer  appear  to  me  to  be  susceptible 
of  a  very  simple  explanation,  as  do  most,  if 
not  all  of  the  other  facts  regarding  the  incidence  of 
the  disease.  Children  appear  to  me  not  to  suffer 
from  cancer  (practically,  of  course,  for  we  have  seen 
that  a  few  cases  occur)  because  they  have  not  had 
time  by  their  food  habits  to  induce  it ;  while  it 
increases  as  age  advances  to  the  middle  period, 
because  the  wrong  feeding  which,  I  suggest,  is  at 
the  bottom  of  it,  and  is  the  chief  cause  of  it,  is 
a  cause  which  goes  on  gaining  power  as  age 
advances.  In  childhood  and  early  life,  irritation 
of  the  organism  is  accompanied  by  intolerance,  and 
therefore   we  find   so  violent  a   reaction   from  the 


411 

over-feeding  of  children  that  the  infectious  fevers 
and  inflammations,  sudden  and  fierce,  and  very 
often  of  short  duration,  are  the  characteristics  of 
childhood.  Up  to  middle  age  this  cause  goes  on 
increasing.  But  as  the  bodily  tissues  harden  and 
become  more  resistant  with  advancing  time,  they 
bear  irritation  better ;  irritation  is  accompanied  by 
tolerance,  and  so  we  find  the  diseases  affecting  this 
period  of  life  less  fierce  than  in  early  life.  The 
bodily  temperature,  instead  of  reacting,  as  in 
childhood  it  mostly  does,  into  elevation  above 
natural,  is  frequently  characterised  by  depression 
below  natural ;  and  so  one  of  the  chief  characteristics 
of  the  pre-cancerous  stage  is  the  existence  of  a 
subnormal  temperature.  Even  in  childhood  this 
condition  is  less  uncommon  than  is  believed.  It 
very  often  precedes  the  onset  of  tubercle,  say  of  a 
joint  like  the  knee,  or  of  some  other  part.  But  in 
middle  life  this  condition  is  much  more  common, 
as  it  is  even  in  adolescence.  The  organism  being 
weighed  down  and  oppressed  by  the  excessive  load 
it  is  being  compelled  to  carry,  and  the  tissues 
being  somewhat  resistant,  it  does  not  intolerantly 
react  against  the  irritation  into  high  fever,  but 
on  the  other  hand  is  simply  depressed  by 
it.  This  is  the  time  to  treat  the  condition  by 
restriction  of  the  diet,  in  order  to  reduce  the 
irritation,  although,  unfortunately,  the  opposite 
advice  is  too  commonly  given,  viz.,  that  the  patient 
should  be  fed  up  in  order  to  elevate  his  temperature. 
Then  the  reasons  why  cancer  becomes  less  common 


412 

over  65  years  of  age  are  simply  these.  Persons  by 
that  time  have  learned  how  to  live.  Those  who 
have  not  learned,  or  who  would  not  learn,  have 
been  swept  away  by  some  of  the  chronic,  or  by 
some  of  the  acute  illnesses  ;  and  nextly,  of  course, 
by  the  time  65  years  has  been  reached,  only  a  small 
proportion  of  those  who  started  life  together  now 
survive,  so  that  the  numbers  of  those  capable  of 
suffering  from  cancer  must  be  much  reduced.  On 
the  other  hand,  of  those  who  do  survive  at  65  years 
of  age,  a  large  proportion  suffer  from  cancer,  owing 
mainly,  I  think,  to  the  wrong  methods  of  living  so 
much  in  vogue. 

It  is  said  that  among  domestic  animals,  dogs 
suffer  from  cancer  to  a  considerable  extent,  while 
pigs  scarcely  suffer  at  all.  If  this  is  the  fact  (I  do 
not  myself  know,  but  I  am  told  it  is  so)  a  likely 
suggestion,  germane  to  what  has  been  just  said, 
occurs  to  account  for  it.  Dogs  are  kept  till  they 
grow  old,  while  pigs  are  as  a  rule  slaughtered 
young.  The  former,  therefore,  have  time  to  con- 
tinue the  action  of  the  causes  which  induce  cancer, 
while  the  latter  have  not.  If,  however,  pigs  lived 
to  old  age,  I  think  it  likely  that,  from  their  greedy 
and  unclean  food-habits,  they  would  develop  cancer 
quite  as  much  or  more  than  dogs — unless,  indeed, 
they  are  immune  to  cancer,  as  some  animals  are 
to  some  diseases ;  but  I  do  not  think  this  likely  in 
the  present  instance. 

But  to  continue  our  inquiry  into  the  causes  of 
cancer    as  connected  with    the   food  habits  of  the 


413 

people.  The  next  point  which  arises  is  that  the 
causes,  whatever  they  are,  affect  women  more  than 
they  do  men.  In  the  years  1896-1900,  126,206 
persons  died  of  cancer  in  England  and  Wales  ;  and 
of  these  49,533  were  males,  and  76,673  females. 
The  males  were  to  the  females  in  the  proportion  of 
two  to  3*1.  There  were  almost  exactly  half  as 
many  more  women  as  men.  But  it  is  found  that 
the  proportion  of  males  who  die  of  cancer  now,  as 
compared  with  females  a  generation  ago,  is  greater 
than  it  used  to  be.  In  the  three  years  1860-2, 
there  died  6536  males  of  cancer,  as  against  14,963 
females,  which  gives  a  proportion  of  two  males  to 
every  4*6  females.  In  the  two  years  1868-9,  the 
numbers  were  5676  females  and  12,578  females,  or 
in  the  proportion  of  two  males  for  every  4*4  females. 
The  proportion  of  males  was  smaller  than  it  is  now, 
and  we  desire,  if  possible,  to  find  out  the  reason  of 
that.  First  of  all,  we  might  ask  the  question,  why 
should  women  suffer  from  cancer  at  a  greater  ratio 
than  men  ?  Is  it  because  of  sex  or  because  of 
habit  ?  The  writer  believes  that  the  cause  is  rather 
habit  than  sex,  as  will  be  said  later.  But  the 
present  question  is  this  :  Seeing  that  women,  for 
whatever  reasons,  suffer  from  cancer  more  than 
men,  how  is  it  that  the  preponderance  of 
the  proportion  of  female  cancer  is  diminishing  ? 
Probably,  the  writer  suggests,  because  the  habits  of 
men  are  approximating  more  in  character  to  those 
of  women  than  was  formerly  the  case.  And  indeed 
this  seems  to  be  so.     The  habits  of  the  English 


4U 

race  are  altering,  and  rapidly.  Under  the  com- 
mercial and  industrial  policy  pursued  by  the  people 
of  the  United  Kingdom  for  the  last  hundi'ed  years 
(free  trade  was  only  an  incident  in  that  policy),  the 
English  race  is  being  more  and  more  congregated  in 
towns,  and  there  is  much  less  difference  than  there 
used  to  be  in  the  habits  and  occupations  of  the  two 
sexes.  It  is  not  now  as  it  used  to  be,  when  women 
performed  the  indoor  occupations  of  life,  and  men 
did  the  more  laborious  out  of  door  work.  Both 
sexes  are  now  doing  indoor  work,  and,  more 
important  than  that,  are  falling  quickly  into 
similar  general  habits,  and  more  particularly  into 
similar  food  habits.  If  women  still  perform  the 
duties  appertaining  to  the  home,  many  of  them 
also  perform  work  strictly  comparable  with  the 
lighter  occupation  now  followed  by  men  in  offices, 
warehouses,  manufactories,  and  mills,  and  women 
also  work  in  mills,  shops  and  offices  much  more  than 
they  used  to  do,  so  that  in  many  respects  the  habits 
of  the  lives  led  by  the  two  sexes  are  identical. 
Men  still,  of  course,  do  the  out  of  door  work  of 
railway  building,  road  making,  sewerage,  drainage, 
waterworks,  iron  production  in  all  its  branches,  and 
heavy  works  of  all  kinds  ;  but  there  has  been  a 
very  great  diminution  of  late  years  in  the  number  of 
men  employed  upon  the  land.  It  is  to  be  hoped  that 
this  is  a  passing  phase  of  things,  but  unquestionably 
for  many  years,  the  land  of  the  country  being  more 
and  more  laid  down  in  grass,  and  the  habits  of  men 
and  women  becoming  more  alike,  fewer  and  fewer  men 


415 

have  been  employed  upon  its  cultivation.  When, 
therefore,  the  habits  of  the  two  sexes  so  much 
approximate  to  one  another  as  regards  occupation 
and  food  habits  as  has  been  the  case  of  late  years, 
it  is  not  surprising  that  they  should  be  found  to 
be  approximating  to  one  another  as  regards  the 
diseases  from  which  they  suffer.  Neither  sex  now 
works  very  hard.  Under  the  influence  of  a  rapidly 
extending  humanitarianism,  legislation  has  been 
very  active  for  some  years  in  shortening  the  hours 
of  labour  in  industrial  work.  But  the  work  of 
women — what  may  be  termed  their  natural  work  at 
home — is  longer  continued  and  more  monotonous, 
and  can  be  much  less  easily  controlled  than  can  that 
of  men.  Their  work  at  home  with  the  children, 
superintending  and  often  performing  with  their  own 
hands  multifarious  household  duties  which  can 
hardly  be  regulated,  and  which  never  seem  to  come 
to  an  end,  is  certainly  trying,  and  often  even 
laborious,  if  in  nothing  else,  then  in  respect  at  least 
of  the  very  long  hours  over  which  it  is  extended, 
much  longer  for  the  most  part  than  in  the  case  of 
men.  Add  to  this  that  the  introduction  of 
machinery  has  greatly  lightened  the  work  of  men, 
and  has  so  far  approximated  it  in  character  to  that 
done  by  women,  a  greater  similarity  now  obtaining 
between  the  kinds  of  work  done  by  the  two  sexes 
than  used  to  be  the  case  ;  and  we  shall  see  some 
considerable  reason  to  understand  how  the  diseases 
of  the  sexes  may  resemble  one  another. 

But  there  is  one  notable  respect  in  which  the 


416 

habits  of  women  differ  from  those  of  men.  They 
eat  oftener.  They  do  not  eat  more,  probably,  than 
men,  but  they  eat  oftener.  It  is  not  uncommon  to 
find  them  breakfasting  about  8  a.m.,  having  some 
lunch  of  tea  and  bread  and  butter  at  10-30  or 
11  a.m.,  having  dinner  about  12-30  or  one,  tea  at 
4-30,  and  supper  at  8  or  9  p.m.  Further,  if  the 
kind  of  food  they  take  is  inquired  into,  it  is  found 
to  consist  (besides  the  chocolates  and  sweets  which 
women  seem  to  be  constantly  taking),  largely  of  tea 
and  bread  and  butter,  mostly  white  bread,  from 
which  some  of  the  natural  constituents  have  been 
removed,  rather  than  brown.  In  fact,  at  each  of 
the  five  meals  (or  four,  if  the  forenoon  lunch  is 
omitted),  bread  is  eaten,  very  often  with  jam. 
Food  is  taken  too  often,  and  the  kind  of  food  is 
mostly  bread  and  sugar.  It  must  be  very  unusual 
to  find  anyone,  man  or  woman,  who  eats  meat  five 
times  a  day,  or  even  four  times  a  day.  To  take 
meat  even  three  times  a  day  is  rather  uncommon, 
and  I  have  never  yet  met  man  or  woman  who  took 
it  oftener.  If  meat  were  taken  as  often  as  bread, 
five  times  a  day,  or  four  times  a  day,  no  doubt  it 
would  set  up  other  forms  of  illness.  It  is  an 
interesting  and  also  a  very  serious  question,  whether 
the  frequent  slight  ailments  of  women,  their  head- 
aches, their  back-aches,  neuralgias^  rheumatism, 
frequent  colds,  and  influenzas,  are  not  in  great 
part  to  be  attributed  to  their  food  habits.  Many  of 
their  ailments  seem  to  be  due  to  habit  rather  than 
to  sex.     How  frequently  and   for   how   long   they 


417 

suffer  from  dyspepsia,  and  indigestion,  and  heart- 
burn ;  and  what  a  large  proportion  even  of  the 
younger  ones  have  lost  their  teeth  from  this  cause. 
Very  often,  indeed,  even  the  first  set  of  teeth  in 
children  are  soft  and  decaying,  and  no  sooner  does 
the  second  set  of  teeth  appear  than  they  are  found 
to  be  decaying  also.  There  is  even  comparatively 
little  difference  between  the  sexes  in  this  respect, 
and  the  little  boy,  as  well  as  the  little  girl,  is  apt 
to  awake,  as  indeed  they  do,  early  in  the  morning, 
with  the  breath  offensive  and  the  mouth  fetid  from 
indigestion  commencing  thus  early  in  life.  Formerly 
the  habits  of  the  sexes  diverged  somewhat  early  in 
life.  Boys  went  to  work  in  the  fields,  while  the 
girls  stayed  at  home  or  went  into  service.  On  the 
whole  the  boys,  and  afterwards  the  young  men,  did 
harder  and  more  laborious  work  than  the  girls,  and 
afterwards  the  young  women.  And,  besides  this, 
the  boys  and  youths,  coming  home  at  regular  stated 
times  for  meals,  kept  on  the  whole  freer  from 
indigestion  than  the  girls  who,  remaining  at  home 
and  feeding  at  other  people's  cost,  got  into  the  way 
of  taking  more  meals  and  at  shorter  intervals  than 
the  members  of  the  other  sex.  The  same  causes 
acting  now  in  the  case  of  domestic  servants  are  the 
chief  factors  in  producing  the  frequent  (I  had 
almost  said  constant)  illnesses  suffered  by  this 
portion  of  the  community,  and  attributed  by  them 
to  any  and  every  cause  but  the  real  one.  Nowadays, 
however,  both  sexes  go  to  school,  and  after  11  or  12 
years  of  age,  to  the  factory,  and  their  habits   are 

AA 


418 

almost  precisely  similar.  When  adult  life  is 
reached,  and  particularly  after  marriage,  the  habits 
may  diverge  again  a  good  deal  for  some  years ;  but 
very  often  both  the  man  and  the  woman  live 
similarly,  perform  the  same  duties,  and  follow  the 
same  avocations.  And,  in  respect  of  health  and 
sickness,  the  same  kinds  of  illnesses  appear  to 
overtake  them.  But  after  the  arrival  of  children, 
the  kinds  of  work  done  by  the  sexes  are  again 
separate,  and  the  women,  staying  at  home  to  mind 
the  children  and  the  house  (although  in  too  many 
cases  women's  work  is  not  so  natural  as  this)  fall 
into  habits  somewhat  different  from  the  men,  and, 
finding  themselves  frequently  suffering  from 
indigestion,  have  recourse  to  frequent  small  meals 
of  bread  and  tea,  which  no  doubt  often  relieve 
them  immediately,  but  mediately  or  remotely  are 
too  apt  to  aggravate  the  dyspepsia  they  were  taken 
to  relieve.  After  a  period,  longer  or  shorter,  of 
experiences  of  this  sort,  and  after  suffering  from  a 
variety  of  ailments  like  those  referred  to,  or 
perhaps  quite  as  often  from  the  frequent  recurrence 
of  some  single  ailment,  like  headache,  or  neuralgia, 
or  influenza,  or  "bilious  attacks,"  or  rheumatism, 
or  a  constant  feeling  of  fatigue,  they  fall  into 
long  continued  or  chronic  ill-health,  and  after  some 
years  are  found  to  be  suffering  from  cancer.  If  the 
other  and  more  trifling  ailments  had  been  properly 
grappled  with ;  if  in  particular  longer  intervals  had 
been  allowed  between  the  meals,  the  indigestion 
and  mal-assimilation,  having  been  prevented  by  this 


419 

means,  and  if  the  food  products  in  their  fermenting 
and  ill-digested  condition  had  been  prevented  from 
entering  the  blood  and  poisoning  it,  no  doubt  the 
occurrence  of  later  and  graver  disease  would  either 
have  been  obviated  or  postponed.  The  indefinite 
postponement  of  illness  is  equivalent  to  its  preven- 
tion. No  doubt  some  sort  of  illness  is  bound  to 
overtake  humanity,  however  physiologically  or 
rationally  it  lives,  for  we  can  hardly  reach  the 
perfection  of  health ;  but  the  more  rationally  we  live, 
the  fewer  of  these  illnesses  will  be  our  portion.  On 
the  other  hand,  the  general  anxiousness  of  the  times 
in  which  we  live,  and  the  interpolation  of  large 
numbers  of  small  meals,  habits  afiecting  all  classes 
of  society,  and  afiecting  men  to  a  larger  extent 
now  than  formerly — all  these  causes  are  having  a 
marked  influence  on  our  population,  and  are  acting 
as  serious  deteriorators  of  health,  and  among  other 
things,  there  can  be  little  doubt,  leading  to  the 
large  increase  of  cancer.  How  this  condition  of 
things  is  brought  about  by  improper  feeding,  and 
how  the  products  of  assimilation  and  of  mal- 
assimilation  of  food  are  carried  by  the  thoracic  duct 
into  the  venous  blood-current,  I  need  not  here 
repeat,  it  being  sufficient  to  refer  the  reader  to 
what  has  already  been  said  on  this  subject  in 
Chapter  Y.  I  may,  however,  add  here  (and  it  will, 
I  think,  help  to  shew  that  the  view  I  am  advocating 
is  not  theoretic  only,  but  has  a  real  and  even  grim 
existence  as  an  actual  fact),  some  experiences  I 
detailed  formerly  regarding  the  causes  of  cancer.     I 

AA2 


420 

saw,  for  instance,  in  the  Bradford  Royal  Infirmary,  a 
woman,  aged  42  years,  "suffering  from  a  large 
infiltrating  malignant  growth  from  lips  of  cervix 
uteri."  (House-surgeon's  note.)  I  had  never  seen 
the  woman  before.  There  was  no  doubt  about  the 
diagnosis  ;  but  I  said  to  the  resident  medical  officer  ; 
"  You  will  find,  if  you  inquire,  that  that  woman  has 
lived  largely  on  carbonaceous  food."  Now  one  has 
to  be  very  sure  of  one's  position  before  making  such 
an  observation  to  a  critical  young  professional  man, 
who  would  in  the  nature  of  things  be  glad  to  gain 
an  advantage  over  a  senior  by  proving  that  he  was 
in  the  wrong.  Had  I  been  wrong,  no  doubt  I 
should  have  heard  more  about  it.  However,  my 
young  friend  inquired,  and  ingenuously  wrote  the 
following  note,  which  I  read  on  my  next  visit  : — 
"  Patient  is  fond  of  bread ;  never  eats  potatoes ; 
eats  rice;  never  liked  meat;  bad  teeth."  I  saw 
with  Dr.  H.  a  man,  set  56,  suffering  from  cancer  of 
rectum.  His  diet  had  been  bread  and  butter  and 
tea  for  breakfast,  sometimes  oatmeal  porridge. 
Dinner  :  meat,  potatoes,  bread,  and  rice,  sago,  or 
tapioca  pudding,  often  Yorkshire  pudding.  Tea  : 
bread  and  butter  and  tea.  Supper  :  oatmeal 
porridge.  The  whole  diet  here  is  starchy,  except 
the  small  piece  of  meat  (viz. :  two  or  three  ozs. )  at 
dinner.  That  starchy  food,  taken  over  a  course  of 
years,  had  fermented  in  his  digestive  tract — how 
often  these  suff'erers  say  they  have  had  a  "poor 
stomach  " — had  poisoned  his  blood,  loading  it  with 
waste  matters,  and  had,  I  have  no  doubt,  led  to  the 


421 

production  of  the  cancer.  In  any  case,  four  daily 
meals,  even  if  they  had  not  consisted  to  such  an 
extent  of  carbonaceous  materials,  would  have  been 
at  least  one,  and  perhaps  two,  too  many ;  and 
would  probably  have  led  to  illness  and  to  early 
death,  whatever  materials  they  had  been  com- 
posed of 

I  asked  the  matron  of  our  small  cancer  hospital 
to  give  at  random  the  diet  of  the  first  three  cancer 
cases  she  chose  to  question.     Here  is  the  result. 

1.  "Mrs.  B.,  eet  55.  Breakfast,  7-30:  tea, 
bread,  bacon  or  egg.  11-30  :  Cheese,  bread,  beer. 
1-30  :  Meat,  potatoes,  vegetables  "  (green  ?  A.  B.), 
"  milk  or  Yorkshire  pudding.  5-30  :  Tea,  bread, 
butter.  10  :  Meat  and  bread."  Note  that  this 
woman  had  five  meals  a  day.  She  had  bacon  or 
egg  for  breakfast,  and  meat  twice  daily,  which  is 
unusual.  But  she  had  bread  four  times  a  day,  and 
if  Yorkshire  pudding  be  counted  (it  is  really  the 
same  thing  as  bread)  five  times.  But  she  lived  to 
55,  and,  I  have  no  doubt,  might  have  survived  to 
65  if  she  had  had  sense  to  keep  to  three  meals,  like, 
say,  her  breakfast,  dinner,  and  tea,  with  proper 
intervals  between  them. 

2.  "Mrs.  S.,  set  69.  8  a.m.  :  Tea,  bread, 
bacon  or  egg.  No  lunch.  12-30  :  Meat,  potatoes, 
sometimes  vegetables  "  (green  ?  A.  R. ),  "  and  potted 
meat.  4-30  :  Bread,  butter,  tea,  and  remains  of 
dinner.  10  p.m.  :  Potatoes,  milk,  or  porridge." 
I  have  not  much  to  say  about  this  case.  The 
woman  survived  to  69,  and  it  may  be  said  she  had 


422 

lived  her  day,  and  must  be  expected  to  die  of 
something.  I  incline  to  think  that,  had  she  had 
one  meal  after  dinner  in  place  of  two,  she  would 
have  been  healthier,  and  would  probably  have  lived 
longer.     But  I  give  the  case  as  I  got  it. 

3.  "Miss  R,  aet  44.  8  a.m.  :  Tea,  bread  and 
butter.  No  lunch.  12-30  :  Potted  meat  and  bread 
taken  at  the  mill.  4  :  Bread  and  the  remains  of 
dinner.  7  :  Tea,  bread  and  butter.  9-30 :  Bread 
and  beer."  Bread  here  was  taken  five  times  a  day, 
and  once  with  beer.  As  bread  takes  five  hours  to 
digest,  often  longer,  let  any  one  imagine  the  state 
of  fermentation  that  that  poor  woman's  digestive 
tract  must  have  been  in  day  after  day,  for  say 
twenty  years,  with  "  tea  "  following  dinner  in  three 
and  a  half  hours,  another  ' '  tea  "  following  the  first 
in  three  hours  more,  and  a  third  "  tea  "  following 
the  second  in  two  and  a  half  hours.  The  only 
meal  which  was  allowed  any  approach  to  a  reason- 
able time  for  its  digestion  was  breakfast ;  and 
dinner  followed  that  in  four  and  a  half  hours,  while 
five  and  a  half  hours  would  have  been  much  better. 
No  wonder  the  poor  thing  did  not  survive  beyond 
44  or  45  years. 

These  are  cases  of  women  in  the  humbler 
walks  of  life.  But  their  well-to-do  sisters  are 
doing  the  same  thing  in  a  difierent  way.  One  of 
them  told  me  some  time  ago  that  she  had  tea  and 
cake,  or  tea  and  bread  and  butter,  at  no  less  than 
three  different  houses  in  one  afternoon,  and  all 
within  two  hours,  or  even  an  hour  and  a  half  of  one 


423 

another.  Well  for  her  if  the  attack  of  indigestion 
which  ensued  on  that  series  of  indiscretions  shall 
teach  her  more  sense,  and  help  her  to  prevent  the 
irreparable  damage  which,  in  one  form  or  other, 
probably  enough  the  onset  of  cancer,  is  certain  to 
ensue  if  she  persists  in  so  insane  a  course.  And 
yet,  how  many  women  are  living '  like  this  ! 

The  statistics  of  the  Board  of  Trade  regarding 
the  immense  increase  in  the  quantity  of  sugar 
imported  into  this  country  in  recent  years,  appear 
to  me  to  support  the  view  I  advocate  regarding  the 
causation  of  cancer.  Of  course,  too  much  stress 
must  not  be  laid  upon  them,  because  much  of  the 
imported  sugar  is  used  in  the  manufacture  of 
articles  again  exported.  Nevertheless,  I  have  a 
general  impression,  corroborated  by  several  con- 
siderations, that  our  people  are  consuming  much 
more  sugar  in  various  forms  than  they  did.  Bread 
and  jam,  as  we  saw  before,  is  one  of  the  cheapest 
forms  of  food ;  but  while  bread  and  jam,  taken 
once  a  day,  may  be  quite  wholesome,  bread  and 
jam  taken  four  or  five  times  a  day  is  a  sickly  and 
even  deadly  diet. 

Here  is  another  case  of  cancer.  "  Mrs.  L.,  set 
50.  Breakfast,  8  a.m.  :  bread  and  butter  and  tea. 
Dinner,  12  :  meat,  potatoes,  Yorkshire  pudding,  rice 
pudding,  bread.  4-30  p.m.  :  bread,  butter,  tea. 
8  p.m.  :  bread,  butter,  stout,  or  quaker  oats,  or 
oatmeal  porridge."  The  perpetual  fermentation 
of  food  so  induced  resulted  in  the  production 
of    a   malignant   ulceration   of  the   mouth   of    the 


424 

uterus.  Cases  of  this  kind  could  be  multiplied 
indefinitely,  and  they  afford  the  kind  of  evidence 
(which  any  one  who  chooses  can  verify  for 
himself)  which  has  led  me  to  the  general  con- 
clusion that  too  many  meals,  and  especially 
when  they  contain  too  large  a  proportion  of  the 
carbonaceous  and  fermenting  foods,  form  a  main 
part  of  the  predisposing  cause  of  cancer.  And  as 
the  habits  of  men  are  now  approximating  more  and 
more  to  those  of  women,  in  the  materials  and  in  the 
number  of  their  meals,  they  are  falling  victims  to 
the  same  terrible  scourge.  Sometimes  one  is  almost 
reproached,  on  being  compelled  to  come  to  the 
horrible  conclusion  that  it  is  cancer  from  which  a 
patient  is  suffering,  to  hear  him  say  :  "  Well,  but  I 
have  lived  so  regularly."  Yes,  they  have  lived 
regularly,  but  regularly  in  a  wrong  or  physio- 
logically unsound  or  vicious  way.  What  can  this 
result  in  but  disease  and  early  death  ? 

But  if  these  are  the  most  important  and  the 
most  potent  causes  of  cancer,  no  doubt  others  are 
contributory.  One  special  form  of  female  cancer  is 
called  morbus  miserice.  Some  poor  women  (not 
always,  unfortunately,  poor  only  In  material 
wealth,  although  this  form  of  cancer  is  commonest 
among  the  conventionally  poor)  being  joined  to 
husbands  who  are  careless,  or  negligent,  or 
inconsiderate,  or  brutal,  and  who  squander  their 
earnings,  or  who  are  perhaps  too  idle  to  have  any, 
suffer  in  quiet  and  uncomplaining  ways  untold 
miseries  lasting  over  years.     Wives  who  are  better 


425 

off  can  often  defend  themselves  by  finding  resources 
in  other  directions  than  those  of  domestic  duty ; 
and  in  the  pursuit  of  pleasure,  or  perhaps  in  works 
of  philanthrophy,  or  of  religion,  solace  themselves 
for  the  loss  of  the  domestic  happiness  which  they 
have  given  up  everything  to  obtain.  But  the  very 
poor  have  no  such  resources.  Compelled,  perhaps, 
to  go  out  charring  in  order  to  find  food  for  their 
children  as  well  as  themselves,  or  even  for  idle  and 
dissolute  husbands,  and  happiness  being  entirely 
unknown  to  them,  some  of  these  women  are  found 
early  to  develope  a  special  form  of  cancer,  termed 
in  such  cases  the  disease  of  misery.  No  doubt, 
some  proportion  of  cancer  may  be  contributed  to  in 
this  way,  especially  as  the  food  habits  of  such  poor 
women  are  generally  those  which  have  just  been 
described,  I  doubt,  however,  if  any  very  large 
proportion  of  the  cases  are  caused  wholly  or  in  part 
in  this  way.  Cancer,  at  any  rate,  although  it  deals 
desolation  among  the  poor,  does  not  spare  the  rich ; 
and  in  the  case  of  most  of  the  latter,  as  well  as 
of  most  of  the  middle-class  women,  it  would  be  out 
of  place  to  speak  of  the  cancer  that  occurs  among 
them  as  a  morbus  miser  ice.  As  regards  anxiety, 
again,  as  a  cause  or  a  contributory  cause  of  cancer, 
it  is  not  easy  to  point  to  much  evidence.  Both 
sexes  suffer  from  the  anxieties  to  which  humanity 
is  subject,  and  each  sex,  no  doubt,  has  its  own 
special  troubles.  If,  however,  one  might  venture  to 
hazard  an  opinion,  men  seem  to  suffer  from  anxiety 
rather  more  than  women,  many  of  whom,  happily 


426 

for  themselves,  appear  to  accept  their  troubles 
rather  in  the  spirit  in  which  children  meet  theirs,  in 
a  matter-of-fact  way  and  uncomplainingly,  as  if 
they  belonged  to  the  nature  of  things  and  to  the 
inevitable.  Men,  on  the  other  hand,  are  more  apt 
to  chafe,  and  fret,  and  grumble,  appearing  also  less 
able  to  derive  comfort  from  the  consolations  of 
religion,  which  act  as  such  a  calmative  to  the 
women.  Suicide,  at  any  rate,  is  much  less  common, 
as  is  the  despair  which  leads  to  it,  among  women 
than  among  men.  It  does  not,  therefore,  seem  easy 
to  say  how  far  anxiety  enters  into  the  causation  of 
cancer.  That  it  is  often  a  contributory  cause  I  do 
not  doubt. 

Some  other  conditions  have  been  said  to  induce 
cancer.  Some  evidence  has  lately  been  brought 
forward  regarding  what  have  been  called  cancer 
houses,  it  being  alleged  that,  in  some  houses,  tenant 
after  tenant  has  succumbed  to  this  disease,  A 
great  fallacy  here  seems  to  be  that,  even  if  this  is 
so,  no  special  inquiry  has  been  directed  into  the 
habits  of  the  successive  residents  who  suffered  in 
these  ways.  Obviously,  much,  almost  everything 
in  fact,  depends  on  this  inquiry.  By  convention 
most  of  us  live  after  the  prevailing  fashion  of  the 
time  :  we  live  as  the  majority  live ;  and  if  the 
habits  of  the  majority  are  unhealthy,  it  may  well  be 
the  case  that  a  succession  of  tenants  occupying  a 
particular  house,  being  at  an  age  suitable  for  the 
development  of  cancer,  might  have  so  lived  as  to 
induce  it ;    or  the   effects  of  the   causes   acting  in 


427 

the  previous  parts  of  their  Hves  might  have 
culminated  during  the  periods  of  their  tenancies, 
the  occupation  of  the  house  being  quite  accidental, 
while  the  influence  of  the  habits  of  the  tenants 
was  the  all  important  factor. 

It  has  also  been  said  that  low-lying  districts, 
wet  and  swampy,  help  in  inducing  cancer  in  their 
residents.  This  is  quite  probable.  Damp  is  a 
contributory  cause  of  most  illnesses ;  and  it  may  be 
admitted  to  be  a  contributory  cause  of  cancer 
also  without  any  damage  to  the  theory  that  far  and 
away  the  most  important  cause  is  wrong  living,  and 
particularly  the  dyspepsia  that  is  induced  by  the 
taking  over  a  long  period  of  time  of  too  frequent 
meals.  Alcohol  does  not  seem  to  have  much 
influence  in  the  causation  of  cancer.  At  least,  m.en 
take  alcohol  to  a  much  greater  extent  than  women  ; 
and  men  do  not  even  yet  suffer  from  cancer  so  much 
as  women.  At  the  most  the  influence  of  alcohol 
might  be  admitted  as  a  contributory  cause  of 
cancer.  Damp  and  alcohol  no  doubt  aggravate 
such  illnesses  as  bronchitis,  pneumonia,  and 
rheumatism,  and  yet  we  find  many  cases  of  each  of 
these  diseases  among  teetotallers,  where,  at  any 
rate,  one  of  these  causes  cannot  be  an  efficient 
factor. 

Such  being,  then,  the  predisposing  causes  and 
such  being  some  of  the  exciting  and  contributory 
causes  of  cancer,  and  since  so  little  prospect  remains 
of  effecting  a  cure  when  the  disease  has  become 
established,  the  great  question  of  prevention  rises 


428 

before  us.  It  has  been  said  that  prevention  is  easy, 
and  in  the  sense  already  explained  this  statement 
may  be  repeated,  it  being  remembered  that  what  is 
meant  is  that  not  theoretical  but  practical  preven- 
tion, that  is,  a  very  considerable  diminution  of 
cancer,  can  easily  be  attained.  As  much,  I  have  no 
doubt,  or  more,  might  be  effected  towards  the 
prevention  of  cancer  as  has  already  been  effected 
towards  the  prevention  of  consumption  and  the 
fevers,  both  of  which,  as  we  have  seen,  cause 
many  more  deaths  than  cancer.  Cancer  might 
easily  be  reduced  by  40  or  50  per  cent,  from 
causing  a  mortality  of  700  per  million  per 
annum  down  to  425  or  350.  If  the  causation  is 
known,  the  question  of  prevention  becomes  quite 
simple.  If  taking  too  many  meals  is  the  main 
cause  of  cancer,  taking  fewer  meals  ought  to  have 
some  influence  in  preventing  it,  and  so  in  checking 
its  course.  I  may  say  here  that  since  I  first  stated 
the  opinion  that  such  was  the  chief  cause  of  cancer, 
a  great  change  has  become  evident  in  medical  views. 
A  clever  medical  critic  of  the  first  edition  of  Air, 
Food,  and  Excercises,  "smiled  "  when  he  referred  to 
it — I  was  going  to  say  discussed  it — but  he  did 
not  discuss  it.  He  only  "  smiled."  Now,  Dr. 
Braithwaite  says  in  so  many  words  that  cancer  is 
caused  by  too  much  food.  So  does  Sir  W.  Mitchell 
Banks,  who  thinks,  however,  that  meat  is  the  chief 
cause.  It  may  be  so  in  the  cases  which  have  come 
under  his  notice ;  but  that  is  not  my  experience,  for 
I  have  found  a  very  large  number,  in  fact  the  great 


429 

majority  of  the  women  whom.  I  have  interrogated 
on  the  subject,  say  that  they  did  not  hke  meat  and 
did  not  indulge  in  it  much.  But  whether  it  is  meat 
or  bread  is  an  accident.  The  principle  is  that  too 
much  food  is  the  cause,  the  chief  cause,  I  mean ; 
and  in  that  opinion  we  are  at  one.  I  hope, 
therefore,  that  the  critic  will  cease  to  smile,  and 
will  preferably  consider  with  candour  a  view  which 
has  some  weight  of  authority  regarding  the 
causation  of  a  disease  from  which  the  people  are 
suffering  and  dying  in  thousands  every  year  even  in 
our  own  country,  and  in  millions  over  the  whole  of 
the  known  world  ;  and  which  none  of  us  can  cure. 
A  smiling  professional  critic  and  a  suffering  and 
dying  people  is  not  a  spectacle  which  commends 
itself'  to  my  sense  of  fitness. 

Dr.  Braithwaite's  statement  regarding  over- 
feeding as  being  a  cause  of  cancer  is  introduced,  by 
the  way,  in  a  pamphlet  which  he  has  written  to 
shew  that  an  excess  of  salt  in  the  diet  is  the  chief 
cause  of  the  disease.  I  have  read  the  pamphlet 
twice,  and  the  argument  appears,  I  regret  to  say, 
weak  in  the  extreme.  His  theory  is  that  "  excess 
of  salt  in  the  diet  is  one  of  four  factors  which  cause 
the  disease."  But  he  does  not  define  what  is 
"  excess  of  salt."  He  is  not  even  certain  in  his  own 
mind,  for  he  remarks  :  "It  is  a  debatable  question 
whether  the  salt  must  be  in  great  excess."  The 
idea  that  salt  was  the  ' '  essential  factor  "  originated 
in  his  mind  by  noticing  that  cancer  of  the  uterus 
was    seldom  or  never   met  with   among   Jewesses. 


430 

But  the  British  Medical  Journal  says  in  the  number 
of  5th  October,  1901  :  "  As  a  matter  of  fact  cancer 
is  extremely  and  increasingly  prevalent  among  the 
Jews,"  So  the  fact  is  denied.  Then  he  states  that 
excessive  meat  eating  is  a  cause  of  cancer  (which 
no  doubt  it  may  be),  and  then  he  goes  on  to  assume 
that  excess  of  meat  means  an  excess  of  salt  (which 
it  may  or  may  not  do).  Now  it  does  not  follow 
that  those  who  take  much  meat  take  also  much  salt, 
and  it  does  not  follow,  either,  that  the  flesh  eaten 
contains  much  salt,  because  the  flesh  of  young 
animals  does  not,  as  a  rule. 

"The  second  point,"  he  continues,  "which  led 
me  to  the  idea  about  salt  is  much  more  certain,  and 
it  is  this  :  In  vomiting  from  cancer  of  the  stomach, 
Vander  Yelden  found  that  there  is  almost  always 
no  free  hydrochloric  acid  in  the  vomit,  whereas  in 
all  other  forms  of  vomiting  it  is  present.  Hydro- 
chloric acid  is  derived  from  salt,  so  that  there 
appears  to  be  some  connection  between  salt  and  the 
disease."  But  surely  if  this  argument  proved 
anything  it  would  go  to  shew  that  absence  of  salt 
and  not  excess  of  it  might  be  a  cause  of  cancer. 
There  seems  indeed  to  be  a  good  deal  of  force  in 
the  arguments  of  Mr.  C.  Godfrey  Gitmpel  that 
deficiency  of  salt  and  not  excess  of  it  is  a  potent 
cause  of  cancer.  He  has  saved  me  the  labour  of 
criticising  the  opposite  view,  and  indeed  I  have 
quoted  him  rather  than  expressed  in  my  own  words 
the  opposition  to  Dr.  Braithwaite's  view,  which  was 
stirred   up  in  my  mind  by  reading  his   pamphlet. 


431 

Mr.  Gllmpers  case  for  the  defect  of  salt  as  a  cause  of 
cancer,  is  so  strong  that  it  seems  to  me  it  must  be 
admitted  as  to  a  certain  extent  proved.  I  still,  how- 
ever, think  that  excess  of  food  is  the  chief  factor,  and 
that  the  accidental  form  which  this  takes  is  usually 
an  excess  of  starch  and  sugar.  The  taste  for  these 
foods  is  usually  accompanied  by  a  distaste  for  salt, 
and  I  think  usually  by  the  habit  of  taking  little  or 
none.  I  think,  therefore,  from  this  consideration, 
and  from  a  general  review  of  the  whole  question, 
that  we  ought  to  consider  deficiency  of  salt  as  a 
contributory  cause,  and  probably  an  important 
contributory  cause  of  cancer.  Mr.  Gtimpel  quotes 
the  statements  of  physiologists  that  the  blood 
CBnnot  exist  with  less  than  2 '5  parts  of  salt  in 
1000  parts,  and  that  it  contains  from  this  proportion 
up  to  six  parts  per  1000  in  varying  conditions. 
In  order  to  keep  the  blood  healthy,  therefore,  I 
am  disposed  to  recommend  those  who  wish  to 
be  free  from  cancer  (and  other  diseases)  by 
simple  means,  to  take  a  cupful  of  water  morning 
and  evening,  containing  a  pinch  of  salt  in  each, 
just  enough  to  make  the  water  pleasant.  A  salt- 
spoonful  of  salt  also  in  the  morning  coflPee  is  a  very 
palatable  addition,  much  pleasanter,  when  one  gets 
used  to  it,  than  sugar.  By  this  means  one  may 
prevent  the  too  great  diminution  of  salt  in  the 
blood,  and  the  too  great  tendency  to  putrefactive 
change  which  such  a  diminution  may  imply,  and  so 
prevent  some  of  the  conditions  which  favour  the 
growth  of  cancer. 


432 

If,  then,  as  I  think,  and  as  I  have  attempted 
to  shew,  too  much  food  Is  the  cause  of  cancer,  if 
taking  too  many  meals  is  the  cause,  if  eating  too 
much  meat  is  the  cause,  or  if  too  much  bread  and 
too  much  sugar  is  the  cause,  combined  with  too 
Httle  salt,  let  us  advise  the  people  to  take  less  food, 
to  take  fewer  meals,  to  take  less  meat,  or  to  take 
less  bread  and  sugar.  Plainly  there  is  sufficient 
agreement  among;  authorities  to  enable  us  to  concur 
in  offering  certain  advice  to  the  people.  I  need  not 
repeat  here  the  statements  made  in  a  previous 
chapter,  regarding  the  time  required  for  digestion, 
or  regarding  the  intervals  which  ought  to  elapse 
between  meals.  I  think  I  may  say,  without  fear  of 
contradiction,  that  two  meals  a  day  is  sufficient  for 
most  people,  and  especially  that  they  are  sufficient 
for  townspeople,  who  now  form  the  large  majority 
of  our  population.  My  advice,  therefore,  to  those 
townspeople  who  wish  to  avoid  cancer  is  to  eat  a 
mixed  diet  not  oftener  than  twice  a  day,  at  say 
seven  or  eight  hours'  interval,  to  eat,  for  instance, 
at  9  a.m.  and  4  or  5  p.m.,  or  at  12  noon  and  7  or 
8  p.m.,  according  to  the  circumstances  of  their 
lives.  And  if  in  quantity  they  do  not  exceed 
about  two  pints  of  fluid  a  day,  and  about  one  ounce 
daily  of  food  for  every  ten  pounds  avoirdupois 
of  their  body  weight,  or  say,  perhaps,  one  and 
a  half  ounce,  I  am  sure  there  would  soon  be 
much  less  cancer  to  chronicle  in  our  midst.  The 
hot  drink  morning  and  evening,  say  with  a  small 
pinch  of  salt  in  it  to  make  it  pleasant,  and  to  add 


433 

to  the  blood  a  necessary  ingredient,  would  be  a 
suitable  part  of  the  diet,  and  would  act  in  the 
way  formerly  suggested.  It  will  be  noticed  that 
this  advice  is  very  much  the  same  as  that  given  for 
the  preservation  of  health  generally.  It  is  the 
simplicity  of  the  advice  that  is  at  once  its  strength 
perhaps  and  its  weakness.  It  is  its  strength 
because  it  is  in  keeping  with  the  view  that 
disease  is  one  in  all  its  varied  and  various  phases, 
and  that  its  chief  cause  is  mal-assimilation  of 
food  from  the  ingestion  of  it  too  often  and  too 
much.  And  it  is  its  weakness  because  people 
expect  to  be  recommended  to  do  some  great 
thing,  some  obscure  thing,  some  difficult  thing, 
in  order  to  be  freed  from  a  disease  hitherto  so 
obscure  in  their  minds  as  cancer ;  and  because 
they  are  apt  to  be  impatient  when  they  are  advised 
simply  to  eat  twice  a  day,  or  once  a  day,  after  the 
age  of  say  55  years.  Also  they  do  not  like  the 
suggestion  that  they  are  or  have  been  too  fond  of 
the  pleasures  of  the  table.  But  common  sense  and 
candour  ought  to  be  great  enough  to  overcome 
these  objections.  Self-restraint  and  self-government 
are  not  sufficiently  commended  to  our  favourable 
consideration  at  the  present  time.  I  think  it  would 
be  well  for  us  if  we  thought  more  of  them ;  and  on 
the  evidence,  as  it  presents  itself  to  me,  I  cannot 
fail  to  press  this  advice  with  what  energy  I  can 
muster,  feeling,  as  I  do  so  strongly,  how  much 
benefit  we  might  as  a  people  reap  from  following  it, 
how  much  suffering  we  might  prevent,   how  much 

BB 


434 

happiness  we  might  attain,  both  for  ourselves  and 
for  our  households,  and  how  much  more  useful  and 
complete  as  well  as  more  happy  we  might  make 
our  lives.  KaXov  yap  to  adXov  /cat  ^  cXtti? 
fieydXr).  For  fair  is  the  prize  and  great  the  hope 
of  attaining  it. 


435 


CHAPTER    XII. 


Some  General  Observations;  and  some  Cases 
illustrative  of  the  General  Conclusion  of 
the  Writer  regarding  the  Chief  Cause  of 
Disease  in  general,  and  of  its  Cure  by 
Diet. 


T  HAVE  now  said  in  principle  pretty  nearly 
all  I  have  to  say  regarding  the  causation, 
or  the  chief  cause  (for  causes  are  always 
multiple,  and  the  causes  of  disease  form  no 
exception  to  this  rule),  of  the  great  mass  of 
diseases  which  afflict  humanity.  In  detail,  of 
course,  each  case  of  disease  is  unique  to  the  person 
aifected  by  it ;  but  the  medical  man,  while  he  feels 
that  patients  very  often  shew  a  certain  amount  of 
resentment  at  having  their  cases  referred  to  a  class, 
or  in  being  classified  themselves,  and  while  he 
would,  perhaps,  if  he  could,  much  prefer  to  let 
them  continue  to  magnify  their  own  importance  by 
encouraging  them  to  think  that  such  a  case  as 
theirs  was  never  known  before,  is  not  unfortunately 
always  able  to  do  so,  and  insensibly  refers  the  case, 
both  as  to  its  causation  and  classification,  to  one  of 
several  groups  which  he  has  in  his  mind.     In  fact, 

BB2 


436 

if  he  did  not  or  could  not  do  so,  there  would  be  no 
possibility  of  science  or  of  philosophy  in  medicine. 
In  this  chapter  I  propose  to  make  some  general 
remarks,  and  to  offer  some  observations  which  the 
reader  will,  I  hope,  be  more  or  less  prepared  for, 
since  the  general  idea  underlying  them  must  by 
this  time  be  familiar  to  him.  And,  besides  these 
general  remarks,  I  have  thought  that  it  would  be 
useful  to  detail  some  further  instances  of  the 
application  to  the  treatment  of  disease  of  the  main 
proposition  laid  down.  That  proposition  is,  that 
disease  is  far  oftener  due  to  mal-assimilation  of  food 
than  to  any  other  one  cause,  and  that,  of  the 
various  forms  of  mal-assimilation  of  food,  excess  of 
consumption  of  good  food  is  a  far  commoner  cause 
of  disease  than  either  deficiency  or  badness  of  food. 
The  description  of  some  additional  cases  in  which 
the  application  of  this  proposition  or  principle  has 
not  only  cured  long-continued  or  recurrent  illnesses, 
but  has  also  prevented  their  recurrence,  will  be  of 
interest  to  the  reader,  and,  still  more,  of  value  to 
sufferers.  For,  as  has  been  said  now  more  than 
once,  while  a  knowledge  of  causes  may  not  enter 
one's  mind,  or  may  not  be  necessary  in  the  treat- 
ment of  illness,  such  knowledge  is  absolutely 
necessary  to  prevention.  And  further,  if  the 
application  of  theories  as  to  causation  enables  us 
to  prevent  the  recurrence  of  a  given  illness, 
especially  if  a  patient  has  often  suffered  from  it 
before,  our  very  success  acts  as  a  piece  of  additional 
evidence  for  the    truth  of   the    theory,    which,   on 


437 

general  principles,  and  as  a  deduction  from  our 
observations,  we  had  been  led  to  adopt.  The 
interest  of  the  public  is  no  doubt  summed  up  in  the 
statement  that  prevention  is  better  than  cure.  For 
the  doctor,  on  the  other  hand,  cure  is  much  better 
than  prevention.  A  trader  is  glad  when  the  prices 
of  commodities  rise ;  the  public  when  they  fall. 
Yet  a  wise  trader  often  manages  to  reconcile  his 
own  with  the  public  interest  by  the  avoidance  of 
cornering  and  other  measures  calculated  to  unduly 
conflict  with  it.  As  to  the  prevention  of  disease, 
the  medical  man,  I  fear,  has  no  chance  of  ever 
making  himself  unnecessary.  Do  as  we  will,  and 
interpret  nature  and  her  laws  as  we  may,  there  will 
always,  I  am  afraid,  be  a  residue  of  illness  which 
our  efforts  will  fail  to  prevent ;  although  I  have  no 
doubt  that  the  residue  would  be  much  smaller  if 
the  methods  of  prevention  proposed  were  more 
likely  to  obtain  not  only  public  sanction,  but  active 
public  support.  The  clergy  and  the  lawyers  are  in 
much  the  same  condition.  The  numbers  of  the 
persons  filling  both  of  these  honourable  professions 
might  be  greatly  diminished  with  advantage  both 
to  the  pubHc  and  to  themselves  ;  but  there  does  not 
seem  to  be  any  immediate  prospect  of  this  result 
being  attained,  since  the  methods  of  self-control 
and  of  the  pursuit  of  justice,  by  which  alone  such  a 
diminution  could  be  attained,  do  not  attract  the 
majority,  but  only  a  small  minority  of  mankind. 
If,  however,  a  medical  man  can  do  anything  in  the 
direction  of  advising  people  how  to  hve   so  as  to 


438 

prevent  disease,  he  will  have  achieved  something 
worth  attaining ;  and  at  all  times  the  medical 
profession  has  advised  its  clients  up  to  its  lights  in 
this  direction,  as  indeed  most  notably  have  the 
clergy,  and  to  some  extent  even  the  lawyers. 

Under  the  terms,  predisposing  causes  and 
exciting  causes,  as  also  under  the  notions  of  cause 
and  occasion  (atrta  and  7r/3o<^acrt9,  as  Hippocrates 
has  it),  I  have  dealt  with  these  ideas  to  some 
extent  already.  What  is  called  Etiology,  or 
Aetiology,  that  is,  causation,  is  too  often  in 
medicine  nothing  more  than  a  Prophasiology,  i.e , 
the  so-called  causes  of  disease  are  very  frequently 
only  its  occasions.  Perhaps  a  few  more  instances 
of  the  kind  of  cases  which  justify  this  statement 
may  be  useful  here.  A  young  man  will  come  to 
the  doctor,  say,  with  a  number  of  suppurating 
pimples  on  the  side  of  his  neck,  just  under  the 
angle  of  the  jaw,  and  will  say  that  friction  by  the 
collar-edge  has  been  the  cause  of  these.  Or  he  may 
perhaps  have  one  large  similar  suppurating  point 
(a  boil),  or,  if  older,  even  such  a  place  with  three 
different  heads  on  the  back  of  his  neck  (a 
carbuncle),  just  where  a  stud  has  been  pressing 
and  rubbing  it.  Or  a  person  may  suffer  from  corns 
on  the  toes,  which  he  may  attribute  to  the  pressure 
of  too  tight  boots  ;  or  he  may  suffer  from  chilblains, 
which  he  attributes  to  frosty  weather.  Or  a 
woman  may  have  a  cancerous  growth  develope  in 
her  breast  through  a  slight  blow  accidentally  given 
her  by  her  own  child,   all    unconscious  and    even 


439 

incapable  of  understanding  the  damage  he  was 
doing.  And  I  have  already  mentioned  the  case  of 
an  old  gentleman  of  87  years  of  age,  who,  being 
knocked  down  by  a  bicyclist,  suffered  from  an 
attack  of  gout.  Now  all  these  alleged  causes  are 
instances  of  prophasiology  rather  than  of  etiology 
— they  are  samples  of  occasions  rather  than  causes ; 
they  are  instances  of  exciting  causes  rather  than  of 
predisposing  causes  —  instances  of  the  action  of 
recent  causes  acting  only  once  or  seldom,  rather 
than  of  the  action  of  remote  causes  acting 
frequently  and  with  cumulative  effect. 

Of  course,  all  these  alleged  causes  were  part 
oi  the  real  causes,  for  without  these  particular 
prophasiologies,  none  of  the  illnesses  mentioned 
would  have  occurred  just  when,  and  where,  and 
how  they  did.  Without  the  fraying  and  rubbing 
of  the  collar  or  stud,  neither  the  pimples  nor  the 
carbuncle  would  have  occurred  just  then  and  there, 
although,  no  doubt,  any  other  slight  cause  or 
occasion  might  have  set  them  up.  Without  the 
frosty  weather  the  chill-blains  would,  or  might 
probably,  not  have  appeared  just  then.  Without 
the  tight  boots  there  would  probably  have  been  no 
corns ;  without  the  blow  cancer  would  probably 
not  have  occurred  just  where  and  when  it  did ;  and 
without  the  bicycle  injury  there  might  have  been 
no  attack  of  gout  at  that  time.  The  reader  must 
not  suppose  that  this  is  a  mere  theoretic  or  academic 
discussion  without  any  practical  consequences,  or 
that    its    consideration    is    like    the    school  -  men's 


440 

question,  "  How  many  archangels  could  dance  on  the 
edge  of  a  razor,  or  on  the  point  of  a  needle  ? "  It 
is  on  the  contrary  full  of  the  grimmest  practical 
consequences.  Without  the  predisposition  none  of 
these  prophasiologies  could  have  been  converted 
into  aetiologies ;  none  of  these  occasions  could  have 
been  the  causes  of  the  illnesses  more  or  less  serious 
which  followed  on  them.  And  to  a  very  much 
larger  extent  than  is  commonly  thought,  we  make 
our  own  predisposition ;  that  is  the  important 
matter.  It  is  not  the  rubbing  by  the  collar ;  it  is 
not  the  frost ;  it  is  not  the  tight  boots ;  it  is  not 
the  blow ;  it  is  not  the  bicycle  accident ;  but  it  is 
in  aU  these  cases  (as  in  a  thousand  others  which 
will  occur  to  the  reader — I  could  multiply  them 
indefinitely,  and,  in  fact,  might  never  be  done)  the 
way  in  which  these  different  people  have  lived 
before  these  events  occurred,  and  it  is  in  particular 
their  previous  food  habits  more  than  anything  else, 
which  have  been  the  real  causes  why  they  suffered 
from  their  illnesses.  If  we  did  not  all  of  us  load  our 
blood,  and  overload  our  blood,  and  that  habitually, 
with  more  food  and  drink  than  we  require,  the 
slight  causes  mentioned  above  would  have  failed 
to  induce  the  illnesses  mentioned.  And  I  emphasize 
food  more  than  drink,  not,  as  I  have  said  before, 
because  I  think  alcoholic  drink  an  unimportant 
cause  of  iUness,  but  because  I  know  food  to  be  so 
much  more  important  a  cause,  that  while  on  the 
whole  only  comparatively  few  of  us  suffer  from  the 
effects  of  too  much  alcoholic  drink,  nearly  all  of  us, 


441 

without  exception,    suffer  from  an  excess  of  food. 
The  way  in  which  the  foundation  then  is  laid  in 
the  hody  for  the  occurrence  of  these  illnesses  from 
causes  so  slight  is  the  way  in  which  disease  begins 
in    the    body,    that    is    its    first    step    is    usually 
indigestion   in   some   form.      And,    beginning   with 
indigestion,  which  is  nearly  always,  or  at  least,  very 
often,   caused  by  too  many  meals  taken  too  close 
together    in    time,    many   varieties    of    illness    are 
apt  to  occur.     It  will  be  useful  to  examine  these 
a  little  more.     There  seem  to  be  two  great  lines 
of  the  development  or  evolution  of  disease.     In  one, 
the  sequence  of  events  is  indigestion,  heart-burn, 
acidity,  the  occurrence  of  watery  blebs  or  blisters 
on  the  lips  or  tongue,  sore  throat  (tonsillitis),  acne 
of  the  skin,  rheumatism  (initis,  I  have  ventured  to 
call   it — congestion  of  connective   tissue,  generally 
lymph  -  congestion   rather    than   blood- congestion), 
constipation,     bronchitis     and     broncho-pneumonia, 
pneumonia    itself,    scanty   high-coloured    urination 
often  accompanied  by  a  heavy  deposit  on  standing, 
insomnia,  eczema,  and  apoplexy  or  cancer.     In  the 
other  we  have  indigestion,  fulness  and  weight  after 
eating,  faintness,  relieved  immediately  by  frequent 
eating,    and    remotely    aggravated    by    the    same, 
enlargement  of  glands  in  the  neck,  the  watery  blebs 
on  the  lips  mentioned  above,  free  urination  without 
deposit  or  precipitate,  tendency  to  free  perspiration 
or  sweating,  the  occurrence  perhaps  of  disease  in 
a  joint   such   as   the    knee,    hip,    elbow   or   ankle, 
anaemia    (triphthsemia,    or    catatribsemia   rather    it 


442 

should  be  called),  pallour  and  attenuation,  feeling  of 
general  or  frequent  fatigue,  peliosis,  or  proneness 
to  become  black  and  blue  on  receipt  of  very  slight 
or  unremembered  injuries,  flushing,  followed  by  cold- 
ness, clamminess  of  hands,  rheumatism,  diarrhoea, 
pleurisy  and  tuberculosis.  Of  course,  these  groups 
of  illnesses,  one  culminating  in  cancer,  and  the  other 
in  tuberculosis,  are  not  definitely  demarcated  off 
from  one  another  ;  but  still,  I  think,  perhaps,  are 
more  or  less  fairly  defined.  However,  the  important 
thing  is  that  they  both  commence  with  indigestion, 
and  the  inference  therefore  rises  before  our  minds  that 
if  this  could  but  be  dealt  with,  all  the  other  evils, 
or  most  of  them  at  least,  could  be  obviated.  Let 
us  look  for  a  little  longer  at  the  course  of  things. 
The  function  of  food  being  to  make  blood ;  w^hen 
indigestion  occurs,  the  blood  is  furnished  with 
ill-made,  ill-digested  stuff.  Some  of  this  gets 
stopped  at  the  capillary  circulation,  or  at  the 
lymph  spaces  beyond,  the  consequence  being  that 
the  lymph  ducts  and  lymph  glands  become  inflamed 
and  may  even  suppurate,  causing  those  so-called 
scrophulous  affections  so  common  among  children 
and  young  persons.  The  word  scrophula,  or 
scrofula,  is  itself  interesting,  and  of  somewhat 
doubtful  etymology.  <iK6pohov  or  ^K6po(f)ov  is  the 
Greek  name  for  a  species  of  onion^  which  the 
enlarged  glands  of  the  neck  were  fancifully 
thought  to  resemble.  By  the  omission  of 
the  o,  the  word  got  altered  to  crKpo^ov,  hence 
aKp6(f)vXov,    and    hence    scrofula    came    to   be    that 


443 

form  of  disease  in  which  the  glands  of  the  neck 
become  enlarged  and  infiltrated,  as  if  onions  were 
dotted  along  it.  Of  late  years  it  has  been  found 
that  the  tubercle-bacillus  is  constantly  or  at  least 
very  often  associated  with  the  suppuration  which 
so  frequently  accompanies  such  gland  inflammation  ; 
and  hence  the  modern  view  of  tuberculosis  is  that 
it  "is  an  infectious  disease  due  to  the  presence  in 
some  part  of  the  body  of  the  bacillus  tuberculosis. ' 
I  do  not  think  this  is  a  proper  statement  or 
definition,  and  think  that  it  would  have  been  better 
to  define  tuberculosis  as  that  state  of  the  body 
which  favours  the  growth  in  it  or  in  some  part  of  it 
of  the  bacillus  tuberculosis.  We  all,  it  seems  to 
me,  so  ubiquitous  are  the  germs  of  tubercle,  have 
them  in  us,  we  are  swallowing  them  in  milk  and 
meat,  and  inhaling  them  in  the  form  of  dried 
sputum  all  the  time.  We  cannot  avoid  doing  so  if 
we  are  to  mix  with  our  fellows,  and  do  the  work  we 
were  intended  to  do  in  life.  It  is  all  very  well  to 
take  all  the  means  we  can  to  avoid  infection,  or  "to 
keep  away  from  it,"  as  we  are  so  often  recommended 
to  do.  But  evidently  beyond  a  certain  (or  un- 
certain) point  it  is  not  possible  to  do  this.  How 
can  a  husband  keep  away  from  his  wife  if  she  has  an 
infectious  illness  ?  How  can  a  wife  keep  away  from 
her  husband,  or  still  more,  how  can  a  mother  and 
father  keep  away  from  the  children  in  such  circum- 
stances ?  Is  it  even  morally  right  that  they  should 
do  so  ?  Or  should  a  man  desert  his  friend  in  such 
circumstances  ?     Is  it  not  rather  cowardly  to  do  so  ? 


444 

In  the  case  of  parents,  or  at  least  of  mothers,  it  is 
hopeless  (as  a  rule)  to  inculcate  or  expect  it.  And 
when  it  seems  possible  by  proper  living  to  get  into 
such  a  state  of  body  and  mind  as  that  we  need  not 
fear  the  pestilence  that  stalketh  in  darkness,  nor 
the  destruction  that  wasteth  at  noonday,  is  it  not 
far  more  to  the  purpose  for  the  medical  profession 
to  attempt  to  educate  the  public  and  shew  them 
how  to  make  themselves  immune  to  infection,  than 
to  fill  them  with  the  fear  and  terror  which  induces 
them  to  try  to  "keep  away  from  it?"  Of  course 
there  is  reason  in  all  things,  and  I  am  not 
advocating  recklessness  in  the  exposure  of  ourselves 
to  infection,  although  I  do  think  the  present 
attitude  of  the  public  in  reference  thereto  is  often 
craven  and  cowardly.  A  little  more  consideration 
of  the  subject,  and  a  little  more  attempt  to  put 
government  and  restraint  upon  ourselves  and  on  our 
appetites,  would  soon  bring  about  a  much  healthier 
and  happier  and  more  courageous  public  opinion  on 
this  subject  of  infection. 

As  regards  the  cure  of  particular  diseases  by 
diet,  one  of  the  first  conclusions  to  which  I  came 
was  that  bronchitis,  as  it  appeared  specially  to  be 
caused  by  errors  in  diet,  was  particularly  amenable 
to  this  form  of  treatment.  This  was  at  that  time 
rather  a  revolutionary  idea  to  my  mind,  because  I 
had  thought,  in  common  with  all  the  world,  I 
suppose,  that  bronchitis  and  broncho-pneumonia,  at 
least,  were  forms  of  "  taking  cold,"  and  were  due  to 
the  action  of  "  cold  "  for  the  most  part,  to  exposure 


445 

to  wind,  cold,  wetness,  ''drafts,"  &c.  Indeed,  it 
seemed  likely  a  priori,  so  to  say,  that  bronchitis 
would  be  due  to  the  action  of  cold  air  inspired,  or 
wet  air,  or  "  draft,"  since  the  function  of  the  lungs 
is  performed  through  inspiration  and  expiration,  and 
any  disturbance  of  the  balance  of  health  in  those 
organs  would  very  likely  be  attributable  to  some 
change  occurring  between  the  body  and  its  relation 
to  air.  An  upset  of  digestion,  on  the  other  hand, 
naight  perhaps  be  readily  enough  attributable  to 
some  error  in  diet,  because  the  function  of  digestion 
is  to  deal  with  food  and  to  convert  it  into  blood  and 
lymph.  This,  I  take  it,  was  the  form  taken  by  the 
unconscious  reasoning  adopted  by  one's  mind,  or 
would  have  been,  if  the  process  had  been  put  into 
conscious  thought.  However,  there  was  this 
amount  of  possibility  that  this  newly  suggested 
mode  of  causation  might  be  the  real  one  that  I 
was  taught  as  a  student,  and  medical  men  had 
for  two  generations  expounded  the  idea  that 
asthma  at  any  rate  was  caused  to  some  extent  by 
errors  in  diet ;  and  if  asthma,  why  not  bronchitis 
also  ?  After  all,  asthma  is  only  a  special  form  of 
bronchitis,  the  form  in  which  as  a  rule  some 
spasmodic  contraction  takes  place  in  the  transverse 
muscular  fibres  of  the  bronchial  tubes,  preventing 
the  patient  from  getting  rid  of  the  air  which  he  has 
forcibly  inspired,  and  which,  remaining  in  his  air- 
cells  loaded  with  carbonic  acid  and  other  effete 
materials,  which  ought  to  be  eliminated  from  the  body, 
poisons  the  patient  more  or  less,  and  leads  through 


446 

the  continually  repeated  and  forcible  inspirations  to 
dilatation  of  his  air-cells,  and  to  other  disease- 
changes  in  the  breathing  organs.  The  patient 
thinks  that  he  cannot  get  air  to  breathe,  while  in 
point  of  fact  he  cannot  get  rid  of  the  air  he  has 
breathed.  He  continues  making  rapidly  repeated 
forcible  inspirations,  while  he  ought  to  be  making 
long  and  repeated  expirations,  so  as  to  rid  his 
respiratory  apparatus  of  the  waste-laden  air  which 
is  oppressing  him  so  sorely.  But  in  treating 
asthma,  my  teachers  and  the  medical  profession 
generally  had  repeatedly  recommended  that  patients 
should  at  least  abstain  from  taking  supper,  and  the 
good  effects  of  pursuing  this  line  of  treatment  were 
generally  admitted.  I  did  not  at  that  time  know 
(say  20  to  25  years  ago,  for  it  was  not  yesterday 
that  more  or  less  vaguely  this  idea  of  the  supreme 
influence  of  food  in  causing  disease  began  to  possess 
my  mind),  I  did  not  then  know  that  the  best  way 
to  treat  severe  asthma  is  to  put  the  patient  either 
on  nothing  (to  make  him  fast),  or  on  say  a  pint  of 
milk  mixed  with  water  each  24  hours,  with  perhaps 
half  a  pint  of  mutton  tea  or  chicken  tea,  and  to 
keep  him  to  this  for  10,  12,  14,  16,  or  20,  or  even 
more  days,  until  his  breathing  becomes  sufficiently 
easy  to  allow  him  to  lie  down,  after  which,  cautious 
increase  of  the  diet  may  be  allowed.  From  for- 
bidding supper,  however,  in  the  treatment  of  asthma, 
a  quite  accepted  method  of  treatment,  to  diminishing 
food  in  other  forms  of  bronchitis  was  not,  or  ought  not 
to  have  been,  a  very  difficult  step.     It  was,  however, 


447 

in  fact,  rather  diJfficult.  Having  suffered  very  much 
from  bronchitis  and  frequently  recurring  colds  in 
my  own  person,  and  having  also  suffered  from 
asthma  so  severely  as  to  be  unable  to  lie  down  for 
nights  together,  and  having  also  had  change  of  air 
prescribed  w'thout  much  or  without  more  than  very 
temporary  benefit,  I  felt  that  something  else  ought 
to  be  done,  and  I  thought  also  that  in  the  nature  of 
things  and  on  general  principles,  it  ought  to  be 
possible  to  do  something  for  a  man  about  40  years 
of  age,  who,  if  not  robust,  had  yet  always  been  fit 
for  any  work  that  had  come  his  way.  About  this 
time  I  read  Dr.  Salisbury's  book,  and  was  by  it,  I 
think  to  some  extent  confused  in  mind  between  the 
effects  of  too  much  food  and  of  too  much  starch 
and  sugar  in  causing  disease,  and  particularly  in 
causing  bronchitis.  As  is  well  known.  Dr.  Salisbury 
recommends  a  diet  of  beef  and  hot  water  in  the 
cure  of  this  and  other  diseases,  and  contends  that 
persons  can  live  indefinitely  on  beef  and  water  alone 
without  the  need  of  any  other  food.  In  my  case 
the  effects  were  good  so  far  as  the  relief  to  the 
asthma  and  the  bronchitis  was  concerned,  and  even 
the  rheumatism  from  which  I  had  suffered  (and 
which  was,  I  now  know,  only  another  phase  or  form 
in  which  the  poisoning  of  my  blood  by  too  much 
food  expressed  itself),  improved  greatly  also.  But 
it  was  some  time  before  I  saw  that  the  relief 
experienced  from  these  ailments  was  not  positively 
due  to  the  beef  I  was  living  on  so  much  as  it  was 
negatively  due  to  the  diminution  of  my  food,  which, 


448 

in  following  the  suggestions  of  his  book,  I  had 
unconsciously  made.  For  I  by  no  means  took  the 
same  quantity  of  beef  that  I  had  formerly  taken  of 
food  in  mixed  meals,  repeated  three,  four,  or  five 
times  a  day,  as  had  been  my  habit.  In  fact, 
4  ozs.  of  beef  taken  three  times  a  day  is  a  very 
restricted  diet,  and  it  was  the  restriction  of  the 
diet,  I  now  see,  which  did  me  good  ;  and  I  believe  I 
should  have  received  as  much  benefit  by  a  re- 
striction to  4  ozs.  of  ordinary  mixed  food  three  times 
a  day,  or  to  6  ozs.  of  the  same  twice  a  day,  as  I  got 
from  the  beef  and  hot  water  ;  and  I  believe  further 
that  I  should  not  have  experienced  the  distressing 
weakness  which  stopping  all  starch  and  sugar 
induced  in  me  for  a  long  time  afterwards.  Studying 
Dr.  Salisbury's  work  and  following  its  precepts  did 
much  good ;  but  it  unfortunately  for  a  time 
confused  in  one's  mind  the  essentially  bad  efiects  of 
taking  too  much  food  (polysiteism  and  pollaki- 
siteism)  with  the  accidentally  bad  efiects  of  taking 
too  much  starch  and  sugar  (poly-amylism  and 
poly-glycism,  and  poUaki-amylism  and  pollaki- 
glycism).  But  the  confusion  did  not  last  long,  for 
it  speedily  appeared  that  to  recommend  say  3  lbs.  of 
beef  to  be  taken  in  a  day  would  be  as  great  an 
error  as  to  recommend  3  or  4  lbs.  weight  of  mixed 
diet,  as  some  physiologists  calmly  do  now.  Three 
pounds  weight  of  beef  taken  daily  is  too  much  food 
for  the  average  man,  and  must  translate  itself  into 
some  form  of  illness,  just  as  much  as  ingesting  3  or 
4  lbs.  weight  of  ordinary  mixed  diet  must  do,  the 


449 

only  difference  being  that  too  much  meat  would 
probably  cause  one  sort  of  illness  (gout,  ^.^.  ?)  while 
too  much  mixed  diet,  and  particularly,  as  in  the 
general  case,  too  much  starch  and  sugar,  would 
probably  cause  illness  of  some  other  sort  (bronchitis, 
e.g.,  or  asthma  ?) 

These  being  the  ideas  in  my  mind,  I  had 
naturally,  in  the  course  of  practice,  many  opportu- 
nities of  putting  them  to  practical  tests.  In  the 
first  edition  of  Air,  Foodj  and  Exercises,  I  described 
the  case  of  a  well-built  woman,  52  years  of  age,  who 
came  to  me,  saying  she  had  suffered  for  twelve 
years  from  what  her  medical  advisers  called  bronchitis 
and  asthma.  She  said  the  attacks  were  very 
severe,  and  were  coming  on  at  continually  diminish- 
ing intervals,  and  with  continually  increasing 
severity.  Attacks  which  used  to  be  three  or  four 
months  apart  were  appearing  at  eight  weeks'  and 
six  weeks',  and  even  three  or  four  weeks'  intervals, 
and  she  was  becoming  worse  and  worse.  The 
question  was,  could  anything  be  done  for  her  ? 
This  seemed  an  unpromising  problem  to  attempt  to 
solve  in  the  case  of  a  woman  no  longer  young,  who 
had  suffered  for  so  long  a  time.  She  was  not  very 
ill,  however,  at  the  time,  as  she  was  able  to  present 
herself  for  treatment.  On  examination  she  was 
found  to  have  catarrh  of  the  larynx,  trachea  and 
bronchial  tubes,  there  being  sibilus  and  rhonchus 
audible ;  and  I  thought  that  there  were  some 
evidences  also  of  emphysaema  or  over- distention  of 
the  air-cells  in  the  lungs.  The  question  was,  what 
cc 


450 

were  the  causes  of  the  recurring  attacks  ?  Unless 
the  action  of  these  causes  could  be  obviated,  other 
attacks  would  certainly  take  place.  On  inquiry, 
however,  it  was  quite  plain  what  the  causes 
were.  Bread  and  butter  and  tea  for  breakfast  at 
8  a.m.  ;  meat,  potatoes,  Yorkshire  pudding,  rice 
pudding  or  jam  pudding,  with  bread,  for  dinner  at 
1-0  ;  tea,  with  bread,  butter,  and  jam  at  4-30  or  5  ; 
and  bread  and  milk  or  boiled  oatmeal  for  supper  at 
8-0,  constituted  the  woman's  ordinary  diet,  and,  in 
my  opinion,  accounted  sufficiently  for  her  attacks. 
At  any  rate,  considering  that  she  was  taking  far 
more  carbonaceous  food  than  she  was  assimilating, 
and  believing  that  the  laryngo-tracheo-bronchial 
mucous  membrane  was  congested  and  irritated  by 
the  deposition  or  precipitation  into  it  from  the 
blood  of  some  of  the  surplus  material  which  had 
found  its  way  into  the  blood  by  such  excess,  I 
advised  an  alteration  of  the  diet  to  three  meals  a 
day,  and  that  she  should  take  bread  only  twice,  and 
jam  and  sugar  not  at  all.  If  she  wanted  any 
supper  she  was  to  have  simply  a  glass  of  milk,  not 
bread  and  milk,  nor  any  oatmeal  porridge.  She 
came  at  weekly  mtervals  for  a  few  weeks.  It  was 
a  little  difficult  to  keep  her  confidence,  because  two 
or  three  of  her  previous  medical  advisers  had  said 
that  the  food  taken  had  no  influence  on  the 
bronchitis.  However,  she  persevered,  losing  weight 
under  the  treatment,  but  losing  also  the  congestion 
of  her  pulmonary  mucous  membrane.  After  the 
lapse  of  about  five  weeks    she    informed    me  that. 


451 

judging  from  her  former  experience,  she  might  expect 
to  have  a  new  attack ;  "  but,"  she  added,  "  I  am  not 
going  to  have  one."  She  has  not  had  any  severe 
attack  of  bronchitis  since.  So  much  for  the  history 
of  this  case  up  till  the  publication  of  the  first  edition 
of  this  book.  On  May  8th,  1902,  this  woman, 
then  63  years  of  age,  came  to  me  suffering  from 
rheumatism  of  both  knees,  or  well  marked  initis  as  I 
have  called  it,  also  from  varicose  veins  in  the  legs 
and  thighs.  The  bronchitis,  she  told  me,  was 
much  better,  and  would  be  better  still,  she  said,  if 
she  "minded  her  diet"  as  I  advised  her,  but  she 
said  she  got  tired  of  it,  &c.  (unfortunately,  humanity 
does  get  tired  of  self-control).  This  rheumatic  and 
varicose  condition  has  replaced  the  bronchitis,  or  it 
has  supervened  on  it ;  but  she  has  not  required 
medical  advice  between  November,  1893,  and  May, 
1902.  Arthritis,  of  right  knee  joint  particularly, 
and  periostitis  of  the  right  tibia  with  varicosity, 
have  supervened  on  the  bronchitis  for  which  she 
consulted  me  about  ten  years  before.  I  point  out 
here  that  this  sequence  of  ailments  corroborates  the 
general  view  I  have  been  driven  to  take  by  the 
evidence,  that  disease  is  one  (in  this  re-discovery  I 
find  I  have  been  anticipated  by  Hippocrates,  and  the 
greatest  of  the  early  medical  writers—  how,  indeed, 
could  it  be  otherwise  ?)  and  also  that  bronchitis  and 
rheumatism  {initts  or  congestion  of  connective 
tissue)  are  different  phases  of  the  same  thing,  viz. , 
an  excess  of  material  finding  its  way  into  the  blood, 
mainly  from  indigestion, 
cc  2 


452 

Let  us  look  at  this  case  a  little  longer.  In 
itself,  of  course,  it  is  not  much.  It  does  not 
concern  the  life  of  a  king  or  noble  or  merchant 
prince,  but  the  principles  underlying  the  sufferings 
of  a  working  woman  are  the  same  exactly  as 
determine  the  health  or  otherwise  of  all  these 
important  personages.  It  may  be  held  that  the 
history  of  the  case  proves  nothing ;  that  the 
recovery  was  a  coincidence ;  and  that  the  woman 
would  have  recovered,  whatever  she  had  done  and 
whatever  food  she  had  taken.  I  do  not,  however, 
take  this  view.  In  view  of  the  facts  that  she  was 
not  young,  that  she  had  suffered  for  so  many  years 
(no  less  than  about  a  quarter  of  her  life),  and  that 
the  opinion  that  an  excess  (specially)  of  carbonaceous 
foods  getting  into  the  blood  through  the  digestion 
produced  material  which  was  deposited  as  an 
inflammatory  exudation  in  the  pulmonary  mucous 
membrane,  is  a  physiologically  correct  opinion,  and 
therefore  that  the  excess  of  these  foods  was  the 
main  cause  of  the  bronchitis — in  view  of  all  these 
considerations,  I  am  compelled  to  the  conclusion 
that  the  recovery  was  no  mere  coincidence,  but  was 
really  the  effect  of  the  treatment.  The  critic  may 
say — well,  the  bronchitis  was  cured,  but  the  patient 
became  rheumatic  (she  was  somewhat  rheumatic 
before,  however),  she  was  not  much  better,  on  the 
whole,  as  she  changed  one  ailment  for  another.  To 
this  I  should  reply  that  she  required  no  further 
medical  treatment  for  ten  years,  and  that  at  63 
years    of    age     one    may    expect    to    suffer    from 


453 

something.  But  I  freely  admit  the  force  of  the 
suggestion,  which,  I  daresay,  occurs  to  the  reader  as 
well  as  to  the  critic,  viz.,  that  it  would  probably 
have  been  better  to  advise  her  to  take  two  meals 
daily  rather  than  three.  I  quite  think  so  myself, 
and  the  good  effects  of  this  advice  in  other  similar 
cases  makes  me  feel  pretty  confident  on  this  point. 
I  do  not  know  if  she  would  have  been  willing  to 
follow  the  advice  even  if  I  had  offered  it.  However, 
much  further  experience  of  the  good  effects  of  this 
advice  has  strongly  confirmed  my  conviction  of  its 
value.  I  have  already,  at  pp.  104-5,  &c.,  related 
the  case  of  a  middle-aged  man  who  put  an  end  to 
the  repeated  attacks  of  broncho-pneumonia  from 
which  he  had  sufiered  by  altering  his  diet.  But 
another  very  interesting  point  in  this  man's  case  is 
that,  whereas  for  several  years  consecutively  he  had 
had  an  attack  of  influenza  in  the  spring,  for  some 
years  past  he  has  ceased  to  have  such  attacks ;  so 
that  I  have  had  the  good  fortune  to  prevent  the 
recurrence  of  successive  attacks  of  simple  inflam- 
mation (broncho-pneumonia),  and  also  of  "fever" 
(influenza),  by  inducing  a  man  to  adopt  the  simple 
course  of  reducing  the  number  of  his  meals  from 
three  or  four  to  two  daily.  I  have  already 
mentioned  the  case  of  a  man  who  had  a  long 
succession  of  colds,  and  also  a  succession  of  attacks 
of  ague  extending  over  thirty  years,  from  the  time 
of  his  leaving  the  West  Indies,  where  he  suffered 
greatly  from  malaria,  but  who  for  ten  or  twelve 
years  now  has  neither  had  a  bad  cold  nor  a  single 


454 

attack   of  ague,  and  this  by  the  simple  remedy  of 
eating   twice,   and   sometimes  once,  a   day.     Here, 
again,     not    only    have    inflammatory    attacks    of 
broncho-pneumonia     been    entirely    prevented    for 
many  years,  but  also  a  fever  like  ague  or  malaria. 
But  I  think  the  most  remarkable  case  I  have  ever 
had  is  the  following  : — An  old  lady  of  72,  feeble, 
thin,   and  attenuated,  had   suffered  so   much  from 
repeated   attacks    of    broncho-pneumonia    that    for 
twenty  years  she  had  been  confined  to  her  house, 
except  that  during  the  warmest  weather  in  summer 
she  sometimes  ventured  to   walk   for   perhaps  ten 
minutes  at  a  time  in  front  of  her  house  in  the  sun. 
By  following  the  simple  advice  of  reducing  her  food 
to   two    small  meals,    one   about   12  noon  and  one 
about    7  p.m.    (both  together    not    amounting    to 
12  ozs.    of  mixed  diet  daily),  this  old   lady,    two 
years  after  I  had  seen  her,  was  able  to  visit  friends 
at  Clayton  and  Bingley,  although  for  over  twenty 
years  she    had  been  unable  to   venture  on  such  a 
thing.     I  must  say  I  was  myself  greatly  impressed 
by   the   results   of  treatment   in   this   case,    much 
more  effective  and  much  more  striking  than  I  had 
ventured  to  hope  for.     This  treatment  is  so  valuable 
and  so  certain  in  bronchitis  and  broncho-pneumonia, 
and  the  evidence  in  favour  of  its  efficacy  is  so  strong, 
that    I   venture    now   to    lay   down   the   dogmatic 
position    that    the     chief    predisposing     cause     of 
bronchitis  is  an  excess  of  food,   and  that  in  most 
cases  the  special  form  of  the  excess  consists  of  such 
foods  as  bread,  potatoes,  puddings,  and  sugar.     Of 


455 

course  it  does  not  follow  that  in  order  to  get  rid  of 
bronchitis  we  ought  to  cease  to  take  such  foods,  but 
it  does  certainly  follow  that  we  ought  to  diminish 
them.  But  bronchitis  accounts  for  about  a  tenth  of 
the  total  mortality  of  this  country  ;  and,  therefore, 
the  inference  is  that  one-tenth  part  of  all  the  fatal 
illness  in  England  and  Wales  to-day  is  amenable  to 
hopeful  treatment ;  and  further,  that  by  proper 
dietetic  management,  bronchitis  is  preventible. 
This  opinion  is,  of  course,  one  fraught  with  very 
serious  and  very  important  consequences.  If, 
however,  we  are  in  the  presence  of  a  physiologico- 
pathological  law  of  the  human  organism,  the 
principle  can  be  put  into  operation  by  others.  If  it 
is,  I  make  bold  to  venture  the  prediction  that  the 
law  will  be  vindicated,  and  that  bronchitis  will  not 
only  be  cured  by  the  inculcation  of  a  suitable  diet 
and  regimen,  but  that  it  will  also  be  found  possible 
by  similar  means  to  prevent  it ;  to  prevent  it,  that 
is,  as  a  rule  (for  I  suppose  there  must  always  be 
individual  exceptions)  between  the  ages  of  five  and 
sixty-five  years.  I  look  on  the  case  in  which 
bronchitis  of  twenty  years'  standing  was  cured  after 
seventy-two  as  too  exceptional  to  allow  us  to 
expect  so  good  a  result  at  that  time  of  life  as  a 
general  rule — although  this  general  view  ought  not 
to  make  one  refrain  from  suggesting  rational  and 
possibly  helpful  treatment  at  any  age,  however 
advanced.  The  facts  already  mentioned  that  "  old 
people  bear  abstinence  weU,  and  that  they  bear 
over-feeding    badly,"  fill   the  medical  adviser   with 


456 

new  hope  in   attempting  to  prolong  the  lives  and 

relieve  the  suflerings  of  the  aged. 

I   do    not    know    how   the    narration   of    the 

following  will  strike  the  reader.     The  writer  lives 

in  Joplin,  Mo.,   U.S.A.     I  have  never  seen  either 

him  or  the  acquaintance  whose  case  he  describes, 

and  it  is  not  likely  that  I  ever  shall  see  either  of 

them,   and   as   there    are  no  relations   between  us 

except  those  of  inacquaiutance,  reasonableness  and 

goodwill,    I   think   all    other   motives    for   making 

the  narration  may  be  put   out  of  account.     After 

stating  that  the  writer  of  the   letter   to   me    had 

"read  repeatedly   and   with  very  great   benefit  to 

himself"    my    first    edition    of    "Air,     Food    and 

Exercises,"  and   asking  some  questions   about   the 

new  edition  of  the  same,  he  continues  : — 

' '  If  you  will  pardon  me,  I  will  give  you  a  little  incident 
showing  the  good  your  book  did  to  another,  and  no  doubt  has 
been  the  means  of  prolonging  a  life.  About  one  year  ago  I 
met  a  gentleman  in  Sumpter,  State  of  Oregon,  U.S.A.,  who 
complained  of  asthma,  saying  he  had  not  been  able  for  ten 
years  to  sleep  in  the  ordinary  position,  but  slept,  bolstered  up, 
sitting  almost  upright  in  his  bed,  not  being  able  to  lie  down, 
on  account  of  choking  so  much  as  to  prevent  sleep.  Eemem- 
bering  your  book,  I  ventured  to  inquire  if  he  ate  a  good  deal, 
and  especially  of  carboniferous  foods,  and  he  replied  in  the 
afl&rmative.  Having  your  book  with  me  at  the  time,  I  offered 
to  lend  it  to  him,  if  he  wished,  and  he  gladly  assented.  As 
he  told  me,  he  read  it  through  six  times,  realising  that  it  fit 
his  case  exactly,  and  he  at  once  put  it  into  practice,  and 
reduced  his  meals  from  three  to  two  a  day,  and  with  immediate 
benefits  of  the  most  marked  kind.  He  is  over  60  years  of 
age,  and  is  a  well  educated  man,  and  a  mining  engineer,  and 
so  has  a  good  knowledge  of  chemistry,  having  devoted  some 
30  years  to  a  study  of  the  chemistry  of  rocks,  metals,  fuels, 


457 

and  water,  but  never  a  thought  did  he  ever  before  give  to  the 
chemistry  of  foods.  Like  a  flash,  he  says,  he  realised  the 
force  of  your  position,  and  began  to  eat  sparingly  of  carbona- 
ceous foods.  Within  two  weeks  he  lost,  to  his  delight,  some 
ten  pounds  of  flesh,  and  found  he  could  lie  down  and  sleep 
like  others,  and  soundly,  and  he  was  as  happy  a  man  as  I 
ever  saw. 

In  telling  his  friends  about  his  wonderful  cure,  he  often 
used  the  following  words — 'Now  I  feel  like  a  bird,  and  can 
sleep  Hke  a  child.'  His  temperate  life  generally  helped  him 
to  a  quick  recovery.  Perhaps  the  good  results  from  your  book 
were  never  expressed  in  the  short  and  original  way  he  did. 
His  name  is  E.  Sanderson  Smith,  Sumpter,  Oregon.  No 
relation  of  me. 

For  myself,  I  generally  omit  breakfasts,  and  eat  but  little 
of  foods  largely  carboniferous,  and  derive  much  good  thereby. 

As  so  many  on  this  side  advocate  free  drinking  of  pure 
water,  whether  thirsty  or  not,  I  have  been  drinking  three  or 
four  pints  of  water  daily,  but  not  during  meals,  though  j 
seldom  or  never  was  really  thirsty  at  the  times. 

I  see  that  Dr.  Dewey,  in  his  late  little  pamphlet,  takes 
very  decided  stands  on  that  point,  advising  that  no  water  be 
taken  unless  actually  thirsty,  and  thirst  should  be  confined  to 
the  three  sources  he  mentions. 

Do  you  wish  to  express  an  opinion  on  the  question  of 
drinking  water  ? 

Also,  Dr.  Dewey  rather  goes  against  special  exercises. 
However,  from  experience,  I  am  strongly  inchned  to  take  the 
view  you  do  as  to  exercise. 

Not  many  of  us  will  agree  with  him  on  the  subject  of 
bathing  the  body,  though  his  plan  of  omitting  the  morning 
meal,  and  his  clear  exposition  of  the  harm  and  danger  of 
eating  to  excess  in  any  event,  has  done  good  to  hundreds,  and 
I  suppose  thousands,  and  has  clearly  prolonged  very  many 
lives,  as,  indeed,  no  doubt  your  work  has  done. 

"With  best  wishes  for  your  happiness  and  continued 
success, 

I  remain, 

Very  truly  yours, 

S.    M.    SMITH." 


458 

As  I  say,  I  do  not  know  how  the  narration  in 
this  letter  will  strike  the  reader ;  but  I  hope  at 
least  he  will  not  grudge  me  the  satisfaction  I  have 
felt  in  reading  it.  As  to  the  points  about  water- 
drinking  which  Mr.  Smith  raises,  I  have  already 
considered  them.  I  think  about  two  and  a  half  to 
three  pints  of  fluid  taken  daily  is  the  gauge  of 
moderation  for  the  average  townsman ;  and  while  I 
agree  with  Erasistratus  (B.C.  300),  that  exercises 
are  not  necessary  to  health  and  life,  believing  that 
the  movements  supplied  by  the  ordinary  business  of 
life  are  physiologically  sufficient  for  that  purpose,  I 
think  that  these  statements  are  true  only  for  that 
small  minority  of  persons  who  do  not  take  too  much 
food.  For  the  majority,  therefore,  I  still  recom- 
mend the  use  of  moderate  exercises,  especially  for 
10,  15,  or  20  minutes  in  the  act  of  dressing  in  the 
morning.  They  help  to  keep  the  body  supple, 
young  and  active,  and  they  render  us  more  active 
and  fit  for  the  prosecution  of  the  work  of  the  day. 

In  the  following  case,  chronic  bronchitis,  lasting 
for  many  years,  led  on  to  a  severe  attack  of  pneu- 
monia, to  which  the  patient  speedily  succumbed ; 
but  the  causes  of  the  bronchitis  and  of  the 
pneumonia  plainly  were  the  same  as  in  the  cases 
just  related.  Some  years  ago  I  saw  in  consultation 
a  stout  man,  54  years  of  age.  The  patient  had 
suffered  for  years  from  what  his  wife  called  asthma 
and  bronchitis,  the  symptoms  being  a  more  or  less 
constant  cough,  with  whistling  sounds  to  be  heard 
in  the  breathing,  and  increase  of  the  cough  when 


459 

he  hurried  or  undertook  exertion.  The  man  was  a 
teetotaller  (how  often,  as  I  have  said  before,  are 
effects,  which  are  really  due  to  wrong  eating, 
attributed  to  alcohol.  They  could  not  at  least  be 
so  attributed  in  the  case  of  a  life -long  teetotaller). 
As  I  say,  when  the  family  doctor  and  myself  saw 
the  man  together,  he  had  most  severe  and  extensive 
pneumonia,  and  the  doctor  had  justly  given  an 
almost  hopeless  prognosis,  too  speedily  verified,  in 
fact.  Now  what  had  this  man's  diet  been  for  many 
years  ?  I  asked  the  question  of  his  wife,  and  she 
told  me  as  follows  : — He  was  in  the  habit  af  taking 
tea  and  bread  and  butter  for  breakfast  at  8  a.m. 
At  dinner  (12-30)  he  would  have  meat,  Yorkshire 
pudding,  bread,  and  rice  pudding.  He  had 
abstained  from  potatoes  for  some  time,  because 
he  thought  them  watery,  and  that  they  tended  to 
puff  or  blow  him  up,  and  make  him  fatter  than  he 
was.  (Note  here  how  the  man  made  the  mistake 
of  thinking  that  it  was  potatoes,  rather  than  too 
much  food,  taken  too  often,  that  made  him  ill.  He 
stopped  potatoes,  but  continued  to  take  bread  four 
times  a  day.  In  point  of  fact,  it  is  not  generally 
this,  that  or  the  other  article  of  diet  that  makes  us 
ill,  but  it  is  too  much  food  of  any  kind  taken  at  too 
short  intervals  of  time.  We  saw  the  same  principle 
in  action  when  dealing  with  cancer,  and  the  reader 
will  see  that  the  causes  of  bronchitis  and  of  cancer 
— as,  indeed,  of  most,  if  not  all  other  illnesses — are 
the  same.)  Tea  at  6  p.m.,  of  bread  and  butter  and 
tea.     Supper,  9  p.m.,  oatmeal  porridge.     The  plain 


460 

causes  of  the  chronic  bronchitis  and  of  the  pneu- 
monia which  supervened  on  it,  were  the  four  meals 
eaten  every  day,  bread  being  taken  at  every  one  of 
them  (for  the  oatmeal  at  supper  has  much  the  same 
composition  as  wheatmeal),  the  Yorkshire  pudding, 
and  the  rice,  which  formed  practically  the  whole  of 
the  diet.  Bread  twice  a  day  is  enough  for  most 
townsmen,  if  they  wish  to  keep  well ;  and  I  have 
no  doubt  that  three  meals  a  day  would  have  been 
much  better  for  this  man  than  four ;  while,  if  he 
had  taken  two  meals  daily,  the  probability  is  great 
that  he  would  have  been  living  now,  without  the 
help  of  doctors.  It  was  not  his  teetotalism  which 
killed  him,  not  at  all ;  but  on  the  other  hand  it 
failed  to  save  him,  as  it  has  in  my  experience  failed 
to  save  a  large  number  of  other  persons  who 
persistently  have  ingested  into  their  bodies  more 
food  than  they  could  assimilate,  or  oftener  than  was 
proper. 

So  much  for  the  dietetic  management  of  those 
who  suffer  from  bronchitis,  asthma,  and  broncho- 
pneumonia. As  to  pneumonia  itself  now  causing  a 
calamitous  mortality  among  the  people,  I  have  no 
doubt  at  all  that  it  is  due  to  the  same  causes  as  the 
affections  just  named.  It  is  not,  however,  quite  so 
easy  to  prove  this,  because  pneumonia  seems  to 
attack  people  suddenly,  when  they  are  in  the  midst 
of  robust  health.  It  has,  in  fact,  seemed  true  often 
that  pneumonia  is  an  affection  of  the  strong  (not 
always,  of  course,  for  delicate  persons  often  suffer 
from  it  also,  and  it  often  enough   ends  life  after  a 


461 

succession  of  illnesses  of  other  kinds).  In  many 
instances,  however,  persons  attacked  by  pneumonia 
have  had  no  previous  illness  at  all  for  years.  I 
remember  very  well  a  gentleman  who  told  me  he 
did  not  know  he  had  a  stomach,  or  a  liver,  or  a 
heart,  or  lungs,  or  any  organ,  because  none  of  them 
troubled  him.  Being  so  strongly  made,  he  lived 
freely,  and  indulged  in  the  pleasures  of  the  table. 
I  cannot  doubt  that  this  was  the  reason  why  he  was 
struck  down  as  by  a  bolt  from  the  blue  by  an  attack 
of  pneumonia,  to  which  he  succumbed  on  the  fifth 
day,  his  sorrowing  family  being  deprived  of  his  help 
just  when  they  needed  it  most,  and  he  himself  of 
life  at  about  fifty  years  of  age.  Recollections  of 
this  kind  crowd  upon  the  medical  man  as  time  goes 
on,  and  seem  to  emphasise  his  determination  to 
draw  attention  to  the  effects  of  free  living — effects 
which,  when  they  have  been  persisted  in  for  some 
time,  are  often  irremediable,  but  which  at  an  earlier 
stage  could  so  easily  have  been  prevented.  Had  he 
taken  two  reasonable  meals  a  day,  I  believe  that 
man  would  have  been  living  now,  and  I  believe  he 
was  strong  enough  to  have  resisted  it,  even  had  he 
taken  at  each  of  them  rather  more  than  he  required. 
Of  course  I  do  not  recommend  this  ;  but  still  many 
of  us  have  so  great  a  resistance  that  even  when  we 
over-tax  our  powers  considerably  (of  course  it  must 
not  be  greatly  overdone)  we  still  live  long  and  have 
good  health, 

Other    recollections     fill    one's    memory,    and 
compel  relation  in  order  that,  if  possible,  men  and 


462 

women  may  be  warned  in  time  of  the  calamities 
which,  although  we  attribute  them  to  fate  or  other 
inexplicable  "  dealings  of  an  inscrutable  Provi- 
dence," are  most  commonly  brought  upon  us  by 
ourselves.  A  heavy  man,  about  forty-seven  years 
of  age,  in  the  very  prime  and  vigour  of  life, 
consulted  me  on  account  of  a  liability  to  "  take 
cold"  frequently  without  suJBScient  cause.  I 
pointed  out  to  him  the  causes  of  this,  viz.,  that  he 
was  ingesting  into  his  body  more  food  than  he 
required  to  maintain  him  in  health  and  strength, 
punctuating  my  opinion  by  drawing  attention  to 
the  facts  that  he  had  indigestion,  and  that  he  was 
too  heavy  for  his  age  and  size.  He  did  not  like  the 
advice  I  gave  him,  and  after  coming  back  once  or 
twice,  ceased  to  return.  In  six  months  I  saw  his 
death  announced  from  acute  pneumonia.  I  quite 
believe  that  when  the  last  illness  overtook  him,  it 
was  too  late  to  save  him.  I  do  not  suppose  any 
other  doctors  could  have  done  any  better  for  him 
than  those  who  were  called  in.  But  I  am  equally 
certain  .in  my  mind  that  if,  six  months  before  his 
death,  when  he  came  to  see  me,  he  had  begun  and 
had  afterwards  continued  to  follow  the  advice  I 
gave  him,  he  would,  after  suffering  at  first,  perhaps, 
from  an  aggravation  of  his  "  colds,"  &c.,  have 
begun  to  recover  from  them,  that  he  would  have 
gradually  thrown  them  off,  and  that  the  calamitous 
illness  which  made  his  wife  a  widow  and  his 
children  fatherless  would  not  have  occurred,  or  if  it 
did,    that  it    would    not    have    terminated   fatally. 


463 

The  medical  man,  like  any  other  scientific  man,  does 
not  make  the  law ;  if  he  did,  he  might  be  tempted 
perhaps  from  a  weak  sentimentality  to  make  it  less 
stringent,  though  I  do  not  for  a  moment  think  that 
that  would  be  a  good  thing ;  but  the  scientific 
man's  duty  is  to  declare  the  law,  the  responsibility 
then  resting  with  other  people  whether  they  will 
obey  it  or  not,  or  whether  they  will  recognise  it  or 
not.  Whatever  they  do,  however,  and  whether 
they  ignorantly  or  knowingly  disobey  it  or  obey  it, 
the  effects  are  inevitable,  and  no  amount  of  protest 
or  of  frantic  appeal  to  be  saved  from  the  conse- 
quences of  disobedience  are  of  any  avail  whatever. 

As  to  rheumatism  and  gout,  very  much  evidence 
has  accumulated  in  my  experience  to  justify  me  in 
saying  that  I  am  satisfied  that  both  of  them  are  due 
to  the  persistent  ingestion  of  food  into  the  body 
over  and  above  its  requirements.  I  have  already 
remarked  upon  the  name  rheumatism,  and  given  the 
reasons  for  the  suggestion  that  we  should  displace  it 
in  favour  of  the  term  or  name  initis,  in  order  to  get 
rid  of  the  obscurity  attaching  to  it.  I  wish  only  to 
add  here  a  word  or  two  about  the  derivation  of  the 
terms  rheumatism  and  gout,  so  as  to  complete  what 
has  to  be  said  about  them.  Rheumatism  comes 
from  the  Greek  pevfxa  =  a  stream,  and  the  name 
was  applied  to  the  pain  which  succeeds  on  the 
stopping  (generally  the  sudden  stopping)  of  a 
watery  discharge  or  stream  of  watery  matter  from 
e.  g. ,  the  head.  To  this  day  the  term  rheum  is  used 
by  some  elderly  people  of  a  watery  discharge  from_ 


464 

the  eyes.  As  the  watery  discharge  comes  from  the 
lymph  and  blood,  and  as  the  blood  gets  its  materials 
from  the  food,  the  name  is  not  a  bad  one  ;  but  my 
reason  for  wanting  to  be  rid  of  it  is  because  it  has 
long  ceased  to  have  that  meaning,  and  because  it  is 
used  of  so  large  a  variety  of  conditions,  that  those 
who  use  it  attach  no  definite  meaning  to  it. 
Rheumatism  is  no  doubt  primarily  congestion  of 
connective  tissue,  or  inflammation  of  it,  which  is  a 
further  stage  •  of  congestion.  The  next  stage  is 
effusion,  effusion  either  of  a  solid  or  of  a  fluid 
exudation,  which  exudation,  however,  is  the 
succeeding  stage  of  all  inflammations.  Wherever 
connective  tissue  is  found  in  the  body,  it  may  be 
congested  or  inflamed ;  and  as  connective  tissue 
forms  the  coverings  of  muscles,  nerves,  and  bones, 
and  as  it  forms  also  the  ligaments  about  joints,  as 
also  much  of  the  tissue  under  the  skin,  rheumatism 
may  arise  whenever  connective  tissue  in  any  of 
these  very  widely  different  parts  of  the  body  is 
inflamed.  Tendons  also  are  made  of  connective 
tissue,  and  hence  tenonitis,  or  inflammation  of 
tendons  is  a  form  of  rheumatism.  Other  forms  are 
neuralgia,  muscular  rheumatism,  periostitis,  shewing 
themselves  in  general  aching,  or  varied  symptoms, 
according  as  the  connective  tissue  of  the  nerves,  of 
the  muscles,  or  of  the  bones  is  affected ;  and  of 
course  the  ligaments  of  joints  may  be  inflamed 
when  we  get  the  joint  inflammation  or  arthritis, 
which  some  authorities  say  is  the  only  real 
rheumatism.     I  do  not  agree  with  this  view  at   all, 


465 

because,  wherever  connective  tissue  is,  it  may  be 
inflamed,  and  inflammation  of  connective  tissue  is 
rheumatism.  Connective  tissue  is  found  also  to  a 
considerable  extent  about  the  brain  (as  well  as 
forming  the  sheaths,  &c.,  of  nerves),  and  hence 
many  phases  of  mind-disturbance  are  associated 
with  its  congestion,  the  flightiness,  e.g.,  uncertainty, 
irritability,  unreasonableness,  depression,  excite- 
ment, and  so  on,  with  various  phases  of  intellectual 
and  moral  perversion  and  perversity,  which,  as  I 
have  already  dealt  with  them  in  Chapter  VIII.,  I 
need  not  here  recapitulate.  The  feeling  of  "  sinking  " 
which  the  women  describe  who  sufier  in  this  way, 
and  the  far  too  frequently  repeated  small  meals 
with  which  they  attempt  to  relieve  it,  reminds  one 
forcibly  of  the  craving  for  alcohol  described  by  the 
alcoholic,  which  he  in  turn  attempts  to  relieve  by 
small  and  frequently  repeated  nips  or  drams.  In 
both  sets  of  cases  the  immediate  eflects  of  in- 
dulgence in  small  and  frequently  repeated  meals 
and  in  small  quantities  of  alcohol  are  to  relieve  the 
sinking  and  the  craving,  and  in  both  the  remote 
effects  are  most  disastrous.  In  both  sets  of  con- 
ditions the  best  method  of  treatment  is  abstinence 
from  alcoholic  drinks  on  the  one  hand,  and  from  food 
on  the  other,  at  least  for  a  considerable  length  of 
time  ;  but  the  latter  advice  is  as  yet  very  seldom 
given,  and  still  seldomer  acted  upon.  However,  as 
I  have  dealt  with  the  matter  already,  I  will  not 
dwell  upon  it  now.  It  has  obviously  come  on  again 
for  discussion  from  our  consideration  of   the  term 

DD 


466 

and  disease  rheumatism,  whose  definition  I  take  to 
be  congestion  and  inflammation  of  connective  tissue, 
and  which  I  therefore  consider  to  be  synonymous 
with  initis.  (Syndesmitis,  from  orvi/8ecr/xetv  =  to 
bind,  would  really  be  the  best  name,  but  unfortun- 
ately this  name  is  not  available,  because  it  has 
already  been  appropriated  to  inflammation  of  the 
ligaments  of  joints,  which  is,  of  course,  one  form  of 
connective  tissue.  One  may  add  a  new  name  to 
Science,  but  to  attempt  to  divert  a  name  already  in 
use  to  a  meaning  diflerent  from  that  to  which  it  has 
already  been  appropriated,  even  when  the  suggested 
change  is  an  unquestionable  improvement,  only  leads 
to  confusion.)  The  term  gout,  again,  is  connected 
with  the  Latin  gutta  =  a  drop,  and  both 
rheumatism  and  gout  were  therefore  considered  by 
the  older  writers  to  be  defluxions  from  the  blood. 
This,  indeed,  they  are,  or  at  least  they  are  either 
fluid  defluxions  from  it  or  solid  exudations  from  it, 
so  that  the  older  ideas  regarding  these  aff'ections 
were  quite  correct,  and  if  we  remember  that  the 
blood  gets  its  materials  from  the  food,  we  have  a 
perfectly  correct  idea  of  both.  Fundamentally,  the 
ancient  idea  regarding  both  rheumatism  and  gout 
that  they  were  caused  by  the  deposition  from  the 
blood  of  materials  present  in  it  in  excess  was  quite 
sound.  Modern  investigations  have  shewn  that 
uric  acid  or  some  of  its  compounds  is  a  common 
form  that  this  exudation  takes,  but  they  have  not 
altered  the  principle  underlying  the  ancient  notion. 
In  rheumatism  many  joints  are  afiected,  the  knees. 


467 

ankles,  elbows,  shoulders,  jaws,  and  many  smaller 
joints  in  the  fingers  and  toes,  the  toe  nails  (and 
even  the  finger  nails  sometimes)  being  often 
distorted  and  overgrown.  (How,  it  may  here  be 
asked,  should  this  be,  unless  the  blood,  containing 
more  material  than  it  requires,  converts  its  excess 
into  overgrowth  ?)  Gout,  on  the  other  hand,  is 
used  of  the  disease  in  which  one  joint,  that  at  the 
ball  of  the  great  toe,  is  specially  affected.  The 
important  thing,  however,  to  remember  is  that  the 
blood  contains  nothing  which  it  has  not  received, 
and  that  the  source  par  excellence,  the  source  com- 
pared with  which  all  others  are  comparatively 
unimportant,  from  which  the  blood  obtains  the 
materials  contained  in  it,  is  the  food.  In  fact  we  eat 
gout  and  we  eat  rheumatism  in  the  sense  in  which 
Sir  Thomas  Browne  said  that  "  we  eat  our  bodies  on 
our  trenchers,"  and  "  devour  ourselves,"  viz.,  we 
manufacture  our  diseases,  and  rheumatism  and  gout 
among  them,  out  of  an  excess  of  food. 

To  shew  that  restriction  of  the  diet  often  cures 
rheumatism,  take  the  following  cases,  which  could 
be  greatly  multiplied.  A  lady,  aged  30,  had 
suff'ered  very  severely  from  chronic  rheumatoid 
arthritis  for  seven  years.  She  had  stiffening, 
swelling  and  distortion  of  her  fingers  and  wrists, 
much  pain  and  stiffness  in  the  back  of  the  head 
and  neck  (an  affection  literally  of  the  Iviov,  or 
strong  tissue  at  the  nape  of  the  neck),  and  she  had 
also  a  large  fluid  effusion  into  one  knee  joint.  For 
this  I  recommended  her  to  eat  once  a  day  (to  be 

DD2 


468 

monositeous),  and  to  take  a  very  small  meal  then. 
She  did  so  for  about  three  years,  and  under  this 
treatment  she  improved  greatly  in  health,  the 
rheumatoid  arthritis  ceased  to  spread,  the  extensive 
effusion  into  the  right  knee-joint  was  absorbed  and 
disappeared,  and  the  pain  and  stiffness  in  the  back 
of  the  neck  were  greatly  diminished.  The  diet  was 
often  weighed,  and  consisted  of  seven,  eight  or  nine 
ounces  of  mixed  food  daily,  a  much  less  quantity 
than  is  generally  taken  or  than  is  usually  required. 
More  strange  is  it  to  add  that  on  this  diet  she 
gained  four  pounds  in  weight  in  about  three  years. 

In  another  case  a  man  had  suffered  inter- 
mittently for  years  from  recurring  attacks  of 
rheumatism,  which  affected  his  muscles  rather  than 
his  joints  ;  that  is,  he  would  find  the  great  muscles 
of  the  back,  or  of  the  thigh,  or  of  the  leg, 
painful  and  sore  as  if  from  over-exertion,  although 
without  adequate  cause  of  that  kind ;  or  if  he  had 
to  hurry  to  catch  a  train,  for  instance,  he  would 
find  the  muscles  of  the  calf  or  of  the  front  of  the 
leg  stiff  and  sore  for  perhaps  a  week  afterwards. 
Sometimes  he  would  find  himself  suffering  from  a 
"  crick  "  in  the  neck,  so  that  he  could  not  move  his 
head  freely  from  side  to  side,  and  if  he  wanted  to 
look  round  would  have  to  move  his  whole  body  in 
the  slow  deliberate  way  adopted  by  those  persons 
who  suffer  from  disease  of  the  spinal  column. 
In  addition,  he  suffered  from  stiffness  and  aching 
about  the  fore-arms  and  about  the  elbow-joints,  and 
sometimes  about  the  shoulder-joints.     One  of  the 


469 

ways  in  which  such  conditions  resulted  was  a 
feeling  of  great  fatigue  on  making  small  exertion. 
For  instance,  on  making  such  small  exertion  as  is 
involved  in  carving  the  meat  at  dinner  for  the 
family,  the  aching  of  the  arms  would  be  so  con- 
siderable, and  the  feeling  of  fatigue  so  great,  that 
he  would  have  to  drop  the  knife  and  fork  for  a  few 
moments  until  rest  enabled  him  to  go  on  again. 
Obviously,  so  sHght  an  exertion  could  not  possibly 
be  the  adequate  cause  of  such  fatigue.  And, 
generally  speaking,  the  alleged  cause  obviously 
never  was  more  than  the  occasion  of  the  annoying 
feeling  of  fatigue  and  of  being  "  overdone."  These 
symptoms  would  come  on  somewhat  suddenly  and 
painfully,  and  after  lasting  for  a  longer  or  a  shorter 
time,  would  pass  off  again  with  as  little  apparent 
cause  for  the  rehef  as  there  seemed  to  be  for  the 
attacks.  From  the  age  of  30  up  to  about  50  years 
these  attacks  annoyed  him,  though  without  ever 
being  severe  enough  to  lay  him  up,  or  not  for  more 
than  a  day  or  so  at  a  time  ;  but  the  attacks  were 
getting  worse.  A  point  in  the  case  was  that  when 
about  50  years  of  age  his  mother  had  had  an  attack 
of  chronic  rheumatism,  as  it  was  called,  which 
confined  her  to  bed  for  several  months,  although  it 
had  not  hindered  her  fi?om  afterwards  attaining 
advanced  life.  Here  seemed  then  to  be  a  case  of 
hereditary  rheumatism  in  the  conventional  sense. 
The  reader,  will,  however,  now  be  prepared  to  view 
the  rheumatism  in  mother  and  son  as  brought  on  by 
similar  causes  acting  on  similar  organisms  in  two 


470 

generations  rather  than  as  cases  of  inherited  disease, 
since  the  man  did  not  begin  to  suffer  until  he  was 
grown  up  ;  and  also  from  the  sequel  of  the  case, 
which  was  this,  that  when  under  medical  advice  he 
reduced  his  meals  from  three,  four  or  five  a  day  to 
two,  and  subsequently  to  one,  he  was  able  slowly 
to  get  rid  of  all  his  troubles,  to  walk  and  move  and 
run  freely,  and  to  suffer  only  at  very  greatly 
lengthened  intervals  from  his  recurring  muscular 
stiffnesses  and  pains,  which,  when  they  did  come, 
were  less  and  less  severe,  and  finally  wore  off.  The 
mother  had  had  to  slowly  learn  the  same  lesson 
also,  and  although  she  never  did  recover  to  the 
same  extent  as  her  son,  still  she  was  able  to  live  in 
comparative  comfort  to  over  80  years  of  age.  But 
so  far  from  the  disease  being  hereditary,  the 
evidence  was  simply  to  the  effect  that  both  mother 
and  son  took  more  food  and  more  meals  than  were 
good  for  them,  and  having  similar  constitutions  or 
organisations  (for  organisation  is  inherited,  though 
disease  very  rarely  is),  suffered  in  similar  ways  ; 
also,  when  the  causes  were  diminished,  that  is, 
when  the  excess  of  food  was  diminished,  both 
mother  and  son  recovered  somewhat,  the  former  a 
little,  and  the  latter  practically  completely.  As  to 
the  second  part  of  the  proof  that  a  recurrence  to 
the  action  of  the  same  causes  re-induces  the  same 
conditions  of  body,  I  have  no  doubt  at  all  that  if 
either  the  lady  first  mentioned,  who  suffered  from 
rheumatoid  arthritis,  or  the  man,  should  return  to 
their  former  way  of  living,  they  would  find  their 


471 

disease  in  both  cases  aggravated.  But  I  do  not 
recommend  either  of  them  to  have  recourse  to  such 
an  experiment. 

The  same  considerations  enable  us  to  under- 
stand many  or  even  most  other  diseases ;  and 
management  founded  upon  our  proper  understanding 
of  them  enables  us  to  effectually  deal  with  them.  I 
have  already  (p.  318)  mentioned  anaemia,  which 
ought  to  be  named  triphthsemia  or  catatribaemia, 
as  has  been  said.  It  is  not  want  of  blood  (anaemia) 
from  which  anaemic  patients  suffer,  but  it  is  loading 
of  their  blood  with  an  excess  of  material  or  of 
waste  matter,  which  is  the  real  malady.  As  the 
chief  source  of  this  is  excess  of  food,  the  chief  means 
of  relief  and  cure  is  and  must  be  restriction  of  the 
diet ;  and  hence  the  young  woman  who  had  seen 
eight  doctors  without  relief  was  greatly  benefited, 
and  in  a  few  months  cured  by  the  diminution  of  her 
food,  her  blood  being  allowed  to  flow  better  to  her 
too  solid  tissues,  as  the  obstruction  to  its  passage 
was  slowly  removed.  I  need  not  repeat  what  has 
already  been  said,  nor  detail  what  I  hope  the 
imagination  of  readers  will  easily  fill  in  each  for 
himself.  The  young  anaemic  woman  was  thin,  pale, 
bloodless-looking,  and  wasted  because  her  blood 
and  tissues  were  checked  or  obstipated  by  unused 
stuff  which  had  entered  her  blood  from  the 
digestion,  and  therefore  relief  was  to  be  expected, 
and  in  fact  was  obtained  only  by  restriction,  the 
opposite  method  in  the  hands  of  eight  different 
doctors   having    failed    to    relieve    her,     or  to    do 


472 

anything  but  aggravate  her  misery.  Many  or  even 
most  other  affections  which  thin  and  waste  and 
lower  the  physique  of  patients  must  be  treated  in 
the  same  way.  Neuralgia,  megrim  or  migraine,  and 
sick  headaches,  for  example,  are  other  examples  of 
similarly  caused  diseases,  which  must,  therefore,  be 
similarly  treated.  These  diseases  are  recurrent  or 
periodic,  as  is  well  known.  Patients  get  an  attack 
of  neuralgia  or  of  megrim,  or  of  sick  headache  (a 
bilious  attack,  as  it  is  often  called),  and  then  they 
recover  and  go  on  for  a  while  till  another  attack 
occurs ;  and  if  one  has  not  in  one's  mind  the 
organic  law  that  constant  causes  acting  on  the 
organism  shew  themselves  not  in  constant  but  in 
periodic  or  intermittent  attacks,  one  is  very  apt  to 
be  deceived  as  to  the  causation  of  these  attacks,  and 
to  imagine,  as  in  fact  patients  do,  that  it  was  that 
draft  or  that  fatigue,  or  that  crowded  room  with  its 
bad  air,  or  that  exposure  to  wet  or  cold,  which 
caused  the  attack,  and  not  the  wrong  food  habits  of 
the  sufferer  which  were  the  real  cause.  We 
confound  the  occasion  with  the  cause  or  mistake  the 
exciting  for  the  predisposing  cause.  The  proper 
translation  or  application  of  the  law,  in  fact,  is 
this ;  Do  we  find  ourselves  suffering  from  a  recurring 
affection  of  any  kind,  then  we  ought  to  search  for  a 
constant  cause  ;  and  in  the  large  majority  of  cases 
that  cause  will  be  found  to  be  wrong  food  habits. 
A  better  statement  of  the  law  would  be  (since 
organic  actions  are  not  so  much  constant  as  inter- 
mittent)  that   causes   acting   at  short  intervals  of 


473 

time  shew  themselves  in  effects  which  appear  at 
longer  intervals  of  time.  Food,  for  instance,  taken 
wrongly  four  or  five  times  a  day  at  intervals  of 
three  or  four  hours,  day  after  day  and  week  after 
week,  causes  effects  which  appear  at  longer  intervals 
of  time,  headaches,  e.^.  or  neuralgic  attacks,  or 
"  bilious  attacks,"  occurring  at  intervals  of  weeks  or 
even  months  apart.  And  the  application  of  the  law 
is  this  :  Do  we  find  ourselves  suffering  from  such 
attacks,  then  we  should  alter  our  habits,  and 
particularly  our  food  habits — i.e.,  we  ought  to 
lengthen  the  intervals  between  our  meals.  This  is 
the  meaning  of  the  statement  of  the  ancient  writers 
on  medicine,  of  Galen,  for  example,  when  he  said 
that  recurring  affections  are  to  be  treated  in  the 
intervals  rather  than  during  the  attacks.  As 
epitomised  by  Andreas  Lacuna  Secobiensis,  he  says 
administramus  remedia,  quum  morbus  non  adest 
sed  futurus  timetur  (we  administer  our  remedies  not 
when  the  attack  of  the  disease  is  on,  but  when  we 
have  reason  to  believe  that  it  is  impending).  In 
his  own  interesting  words  he  says  : — etSe  aKy^r}^ 
7rapov(Trj<s  voarjjjLoiTcov  ovk  eial  Kaipoi  TbiV^orjBiqiiaTOiV, 
Koi  jxr)  ovTO)v  voarjfxaTOJV  etcrt  Kaipol  ^orjdyjfxaTCJV, 
<f)av€pov,  OTL  OVK  eTTivoia  fiovov  dXXa  /cat  vTrocrracnv 
hia^epovdiv.  (For  it  is  evident  that  the  times  of 
the  occurrence  of  the  paroxysms  of  (recurring) 
diseases  are  not  the  proper  occasions  for  the 
administration  of  remedies,  but  that,  on  the  other 
hand,  the  times  for  favourably  affecting  (recurrent) 
diseases  are  the  intervals  when  they  are  not  present. 


474 

since  opportunities  for  treatment  differ  not  only  in 
our  view  of  disease,  but  in  its  own  nature. )  We 
can,  in  fact,  do  little  except  to  attempt  to  palliate 
or  relieve  an  attack  of  neuralgia  or  sick  headache 
or  "biliousness,"  or  of  recurring  bronchitis  or 
broncho-pneumonia  when  it  is  on,  but  we  can  do 
much  to  prevent  subsequent  attacks,  to  lengthen 
the  intervals  between  attacks,  and  to  render  the 
attacks  less  severe,  when  or  if  they  do  occur.  But 
recurring  attacks  tend  to  become,  and  are  on  the 
way  to  becoming,  chronic  or  long  continued,  and  the 
chief  way  in  which  we  ought  to  handle  chronic 
illness  also  is  to  alter  the  habits,  and  particularly 
the  food  habits.  For  even  chronic  illnesses,  that  is, 
illnesses  which  are  always  present,  are  not  always 
equally  present,  or  are  not  present  always  in  equal 
degree  or  extent.  Like  the  recurring  affections 
from  which  they  are  developed,  they  have  their 
periods  of  exacerbation  and  of  recession,  they  are 
better  and  worse.  And  they  often  go  on  to  or 
pass  into  other  affections,  or  what  seem  to  be  other 
forms  of  disease.  Recurring  sick  headaches  or 
bilious  attacks  frequently,  for  example,  lead  on  to 
attacks  of  chronic  rheumatism  or  to  the  formation 
of  some  bony  or  other  tumour  or  growth,  which 
could  have  been  prevented  had  the  patient  been 
advised  earlier  how  to  deal  with  the  sick  headaches 
in  the  intervals  between  the  attacks.  A  woman, 
for  instance,  whom  I  saw  for  recurring  sick  head- 
aches many  years  ago,  and  whom  I  was  able,  by  the 
administration  of  medicine,  greatly  to  relieve  from 


475 

the  severity  and  frequency  of  her  attacks,  sent  for 
me  some  years  afterwards  on  account  of  the  onset  of 
inflammation,  pain,  sweUing,  and  stifiness  of  the 
joints  of  her  fingers,  of  the  nature  of  rheumatoid 
arthritis ;  and  some  years  after  that  time  I  saw  her 
again  for  an  incurable  bony  tumour  of  her  pelvic 
bones,  a  form  of  cancer  no  doubt.  Twenty-five 
years  ago,  when  I  first  saw  this  woman,  I  was  not 
so  profoundly  impressed  as  I  am  now  by  the  power 
of  food  to  cause  health  and  to  cause  illness,  nor  did  I 
then  know  how  much  more  helpful  I  might  have  been 
to  that  patient  than  in  fact  I  was.  If  I  were  to  see 
her  now  for  the  first  time,  I  should  strongly  impress 
on  her  the  advisabihty  of  eating  twice  a  day,  and 
twice  only  (she  is  a  teetotaller,  so  that  here  again  the 
cause  is  not  alcoholic  drink)  up  to  say  fifty  years  of 
age,  and  once  daily  after  that  age ;  so  that  the 
cause  of  the  evils,  which  I  did  not  then  foresee,  but 
which  I  now  know  to  have  been  wrong  living, 
might  not  continue  to  act,  and  so  that  she  might, 
escaping  both  her  rheumatoid  arthritis  and  her 
incurable  pelvic  disease,  have  settled  down  into  a 
serene,  painless,  and  placid  old  age.  Perhaps  she 
might  not  have  taken  the  advice ;  but,  however  this 
might  have  been,  I  at  least  should  have  been  able 
to  feel  that  I  had  warned  her  beforehand  of  what 
was  impending,  and  so  have  afforded  her  the 
opportunity  of  escaping,  if  she  wished,  from  the 
evils  before  her.  So  much  in  the  way  of  evidence 
to  shew  that  gouty  and  rheumatic  affections  depend 
upon  wrong  food  habits  more  than  upon  any  other 


476 

single  cause ;  that  their  cure  and  amehoration, 
therefore,  depend  rather  upon  restriction  of  the  diet 
than  upon  any  other  single  measure;  and  that 
recurrence  to  former  food  habits  is  the  most  potent 
influence  in  re-inducing  the  former  disease- 
conditions.  Of  course  other  causes  may  be  con- 
tributory to  the  induction  of  rheumatism  or  gout. 
Damp,  wet  subsoil,  for  instance,  and  bad  drainage 
may  be  subsidiary  causes,  and  therefore  some 
improvement  and  amelioration  may  be  obtainable  by 
removal  to  a  drier  soil  (from  clay  to  sand,  for 
instance)  and  to  better  and  drier  climatic  conditions  ; 
but,  on  the  other  hand,  much  improvement  and 
even  cure  are  often  obtainable  without  having 
recourse  to  these  costly  adjuvants,  beyond  the  reach 
of  the  means  of  many  sufferers,  by  the  simple  device 
of  restricting  the  diet. 

As  to  the  cure  of  recurring  ailments,  like  sick- 
headaches,  bilious  attacks,  and  the  like,  and  the 
relation  of  these  affections  to  ailments  so  wholly 
different  apparently,  as,  for  instance,  tumour- 
growths,  take  the  following  case.  A  woman  aged 
thirty  had  a  large  ovarian  tumour  which  it  was 
necessary  to  remove  by  operation.  She  also  suffered 
from  dyspepsia,  anaemia,  and  recurring  sick-head- 
aches, and  '*  bilious  attacks,"  which  would  confine 
her  to  bed  helplessly  for  a  day  or  two  at  a  time  at 
weekly  intervals  or  so.  After  I  had  removed  the 
tumour,  and  had  so  obtained  her  increased 
confidence  and  that  of  her  husband  and  family,  I 
advised  her  to  eat  once  a  day,  and  once  a  day  only, 


477 

in  order  to  prevent  the  formation  of*  some  other 
tumour  or  morbid  growth  in  the  body,  as  also  to 
obviate  the  recurrence  of  her  indigestion,  her 
anaemia,  her  sick-headaches,  and  her  bihous  attacks. 
The  effect  of  this  advice  was  immediate  in  the  great 
amelioration  of  all  her  symptoms ;  and  now  at  the 
close  of  about  a  year  after  the  institution  of  these 
changes,  or  I  ought  to  say  of  this  one  small  change 
in  her  mode  of  living,  she  has  no  dyspepsia,  she  is 
reheved  of  her  constipation,  and  has  no  more  than 
a  suggestion  from  time  to  time  of  her  former  sick- 
headaches  and  bilious  attacks,  and  has  never  been 
laid  up  for  a  day  by  the  enemies  which  used  so  to 
annoy  and  worry  her.  That  continuance  in  this 
way  of  living,  besides  ridding  her  of  present 
ailments,  will  be  the  best  means  also  of  preventing 
the  onset  of  other  diseases,  like  the  chronic 
rheumatism,  the  rheumatoid  arthritis,  or  the  bony 
growth  suffered  from  by  the  other  woman  referred 
to,  as  also  that  it  will  probably  afford  the  best 
protection  against  the  formation  of  some  other 
malignant  growth  in  the  body,  and  against  the 
occurrence  in  the  stump  of  the  removed  ovary,  of 
some  cancerous  growth,  I  have  and  can  have  no 
doubt.  And  if  there  is  any  self-restraint  required, 
or  suflering  endured  by  voluntary  submission  to 
such  restriction,  it  may  reasonably  be  contended 
that  these  inconveniences  are  much  less  and  much 
more  easily  borne  than  the  compulsory  restraint, 
and  confinement,  and  suffering,  and  annoyance 
inflicted  by  nature  as  the  penalty  for  breach  of  her 


478 

laws.  The  nexus  between  cause  and  effect  does  not 
seem  to  me  to  be  at  all  difficult  to  see  ;  but  whether 
we  see  it  or  whether  we  do  not,  the  penalty  comes 
inevitably  for  any  breach  of  nature's  laws.  And 
conversely,  when  we  find  ourselves  suffering  from 
any  recurring  ailment,  we  ought  to  inquire  whether 
we  are  not  in  some  simple  and  plain  way  breaking 
some  natural  law,  and  whether  by  the  means  of 
treatment  we  are  adopting  for  it,  by  the  use,  e.g^^ 
of  an  aperient,  or  of  hypodermic  injection  of 
morphia,  or  of  antipyrin,  phenacetin,  phenalgin,  or 
other  drug,  we  are  not  simply  palliating  and  mask- 
ing symptoms,  which  would  disappear  of  themselves 
if  our  ideas  of  treatment  were  to  go  back  to  the 
digestive  causes  of  our  sufierings.  In  very  few 
cases,  indeed,  would  such  a  line  of  treatment  fail  of 
affording  relief  When  it  did  we  might  perhaps 
begin  to  institute  inquiries  further  back  still,  and 
see  if  some  hereditary  predisposition  were  not  at 
the  foundation  of  our  suffering — which,  if  it  were 
so,  would  raise  considerations  which  I  will  not 
pursue  further  at  present. 

Another  case  in  which  recurring  sick-headaches 
were  cured  by  changes  in  the  diet  recently  came 
under  my  notice,  and  I  mention  it  here  because  it 
illustrates  how  the  law  can  be  put  in  action  without 
the  intervention  of  the  medical  expert  at  all,  just  as 
any  other  law  of  nature  can  be  in  any  other 
department  of  nature  when  the  law  is  known.  A 
young  lady,  22  years  of  age,  recently  told  me  this 
interesting  story.     She  suffered,  she  said,  from  the 


479 

age  of  ten  or  twelve  years  from  recurring  sick- 
headaches,  sometimes  accompanied  by  severe 
vomiting,  which  would  compel  her  to  betake  herself 
helplessly  to  bed  for  a  day  or  perhaps  two  days  at  a 
time,  during  which  time  she  could  take  no  food  at 
all.  These  attacks  continued  up  to  within  two 
years  of  the  time  when  I  met  her,  that  is,  up  to 
20  years  of  age.  About  that  time,  partly  through 
reading  one  of  Dr.  Dewey's  books,  and  partly 
through  other  reasons,  she  adopted,  and  that  in 
spite  of  the  ridicule  of  some  of  her  young  friends,  a 
dissiteous  regime,  in  place  of  the  trissiteous  or 
tetrasiteous  course  which  she  had  formerly  followed. 
Almost  from  the  very  first,  she  said,  she  had 
experienced  benefit,  and  in  a  few  months  she  was 
quite  cured,  by  taking  no  more  than  two  daily 
meals,  of  headaches  which  had  annoyed  her  for  not 
less  than  eight  or  ten  years.  When  I  saw  her  she 
was  nursing  her  little  brother,  and,  as  he  was  very 
ill  indeed,  her  duties  compelled  very  close  waiting 
upon  him.  As  she  could  not  leave  his  room  to  take 
any  exercise  in  the  open  air,  she  thought  she  ought 
to  become  for  the  time  being  monositeous,  that  is, 
that  she  ought  to  eat  only  once  a  day  ;  and  at  the 
time  of  which  I  speak  she  had  been  doing  this  for  a 
fortnight,  a  course  in  which  I  encouraged  her  to 
persevere  as  long  as  the  circumstances  lasted  which 
led  her  to  adopt  the  plan.  Of  course  the  original 
suggestion  of  dissiteism,  or  the  later  one  of  mono- 
siteism,  was  not  mine  at  all.  She  had  heard  of  the 
law  that  sick-headaches  were  due  to  too  many  meals ; 


i80 

she  applied  the  law  and  got  cured.  The  suggestion 
subsequently  of  monositeism  to  meet  her  temporary- 
deprivation  of  exercise  was  also  of  her  own  making, 
on  the  very  reasonable  ground  that  as  there  was 
so  much  less  expenditure  of  physical  and  kinetic 
energy,  there  was  the  less  reason  to  ingest  so  much 
potential  energy  into  the  body,  as  before,  in  the 
form  of  food ;  and  her  rosy,  plump,  and  healthy 
appearance  appeared  to  me  to  completely  justify 
her  application  of  the  law. 

The  same  principles  underlie  the  causation  of  all 
recurring  afiections  of  the  animal  economy.  What 
the  tissue  or  organ  which  is  affected  may  be  is  an 
accident.  We  have  seen  how  the  law  applies  to 
affections  of  the  bronchial  mucous  membrane,  and  of 
the  lung  tissue,  to  rheumatic  affections,  and  in  cases 
of  sick-headaches.  But  affections  of  any  and  every 
part  come  under  the  same  law.  For  instance,  here 
is  a  case  of  skin  affection  which  was  successfully 
treated  by  dietetic  management.  A  young  woman, 
who  had  suffered  for  many  years  from  recurring 
attacks  of  erysipelas  of  the  face,  and  who  for  many 
months  before  I  saw  her  had  been  prevented  by  her 
illness  from  following  her  occupation  as  a  weaver, 
and  whose  face  was  distorted  almost  beyond 
recognition  by  repeated  attacks  of  her  malady,  was 
informed  that  her  diet,  consisting  largely  of  bread, 
potatoes,  puddings,  and  sugar,  was  the  chief 
predisposing  cause  of  her  recurring  illnesses.  (The 
essence  of  the  cause  was  too  much  food ;  the 
accident  was  too  much  starch  and  sugar.)     She  was 


481 

advised,  therefore,  to  eat  bread  only  once  a  day,  and 
then  not  more  than  four  ounces,  and  to  have  for 
dinner,  if  she  could  get  it,  three  or  four  ounces  of 
any  meat,  with  some  lettuce  or  other  green  vege- 
table. She  was  also  advised  to  diminish  greatly  her 
puddings  and  sugar.  She  did  so,  and  very  soon  the 
attacks  of  erysipelas  began  to  come  less  frequently 
and  with  diminishing  severity,  and  in  the  course  of 
a  few  months  she  became  very  much  better.  As 
she  had  improved  so  much  she  after  a  time  thought 
that  she  need  not  be  so  particular  about  her  diet, 
but  might  do  as  other  persons  of  her  acquaintance 
did.  (It  is  almost  always  a  puzzle  to  patients  when 
they  are  told  that  so-and-so  is  the  cause  of  their 
illness,  to  answer  the  question,  why  is  it,  then,  that 
the  same  causes  do  not  make  their  friends  and 
acquaintances  ill  in  the  same  way  as  themselves. 
"If,"  they  say,  "I  am  made  ill  by  bread  and 
puddings,  why  are  not  A.B.  and  CD.,  whose  habits 
I  know  very  well,  and  who  take  even  more  of  these 
foods  than  I  do  ?  Why  are  they  not  made  ill  in  the 
same  way  ? "  The  answer  that  different  persons 
have  different  resistances  to  these  things,  and  to 
the  physiological  labour  required  for  their  digestion 
and  assimilation,  does  not  seem  to  satisfy  them.  It 
is,  perhaps,  not  a  very  satisfactory  explanation, 
although  it  is  all  the  explanation  which  we  can 
give.)  My  patient,  at  least,  thought  she  might  do 
as  her  friends  and  acquaintances  did,  and  after 
recovery  took  more  of  these  foods  than  she  had 
been     advised    to    take.       The    erysipelas    faciei 

EE 


482 

recrudesced,  after  which  she  made  no  more 
experiments,  but,  restricting  herself  to  what  she 
had  been  advised,  remained  well.  The  proof  that 
the  alleged  cause  of  the  erysipelas  was  in  such  a 
case  the  real  cause  requires  no  additional  confirma- 
tion. 

The  successful  treatment  of  erysipelas  of  the  face 
by  alteration  of  the  diet  raises  another  interesting 
question  besides  merely  that  of  the  treatment 
and  successful  prevention  of  a  recurring  inflam- 
mation. Erysipelas  has  been  shewn  to  be  associated 
with  (the  conunon  view  would  be  that  it  is  caused 
by,  but  I  have  already  frequently  given  reasons  for 
dissenting  from  this  interpretation  of  the  facts)  the 
growth  of  a  micro-organism  in  the  blood  and  tissues. 
This  being  so,  erysipelas  asserts  its  relationship  to 
the  fevers,  whose  course  is  associated  with  the 
growth  of  these  micro-organisms,  and  not  merely  of 
an  inflammation  whose  course  is  not  known  to  be 
so  associated.  Whether  the  micro-organism  is 
a  coccus,  as  in  this  instance,  according  to  Fehleisen, 
it  is,  or  a  bacillus,  makes  no  more  than  an  accidental 
and  unimportant  difierence.  On  this  view,  if 
erysipelas  is  not  a  fever,  it  is  at  least  a  *'  specific 
inflammation."  At  any  rate  it  is  not  a  simple 
inflammation.  But  whether  we  view  it  as  a  fever 
or  as  a  specific  inflanamation,  the  very  interesting 
and  very  important  fact  stands  out  that  the 
presence  of  the  microbe  does  not  render  the  disease 
any  less  amenable  to  dietetic  treatment  than  if  it 
had   been   a   simple    inflanomation    which  was   not 


483 

associated  with  the  growth  of  micro-organisms  at 
all.  However  the  coccus  entered  the  system,  it 
thrives  in  tissues  that  are  over-fed,  particularly  as 
it  happens  with  bread  and  starchy  stuffs,  although 
the  kind  of  food  may  be  (?)  an  accident.  And  this 
being  so,  whenever  the  over-manuring  of  the  soil  is 
reduced  to  what  is  fitting  and  proper,  the  disease 
dies  down,  or  rather,  and  as  I  much  prefer  to  say,  the 
body  (that  is  the  soil)  returns  to  a  condition  which 
renders  it  unsuitable  for  the  continued  growth  of 
the  coccus,  the  coccus  dies  down  and  the  patient 
recovers.  The  whole  question  of  the  management 
of  fevers  is  raised  by  this  simple  issue,  and  it  is  on 
evidence  of  this  kind,  and  on  this  kind  of  reasoning 
among  others,  that  my  opinion  is  founded  that  in 
the  management  of  the  fevers  more  attention  should 
be  devoted  to  dietetic  conditions,  and  that  dietetic 
conditions  should  be  considered  by  the  medical 
adviser  more  than  questions  merely  as  to  air-supply 
and  overcrowding  and  infection.  Until  we  deal 
with  food-supply,  I  do  not  think  we  ever  shall 
effectually  deal  with  fevers  (or  with  consumption). 
I  have  just  to  add  the  single  word  that  erysipelas  is 
an  affection  so  infectious  when  once  it  has  started, 
that  surgeons  have  the  most  wholesome  horror  of 
allowing  it  to  be  near  wounds,  since  they  know  that 
its  presence  is  very  apt  to  set  up  blood-poisoning  in 
their  patients.  Even  in  this  case,  however,  some- 
thing, nay,  very  much,  will  depend  on  how  the 
patients  suffering  from  wounds  have  been  fed — 
although,  of  course,  I  freely  admit  the  duty  of  the 

EE  2 


484 

surgeon  to  keep  his  patient  clear  from  all  sources  of 
infection  as  far  as  he  can.  These  facts,  however, 
seem  to  me  to  be  very  instructive  as  to  the  causes, 
the  origin,  the  spread  and  the  treatment  of  specific 
inflammations,  and  their  relations  to  fevers. 

In  erysipelas  the  skin  is  red,  even  very  red. 
Redness,  in  fact,  and  erysipelas  mean  much  the  same 
thing.  Pain,  redness,  heat,  and  swelling  are  the 
cardinal  symptoms  and  signs  of  inflammation,  and 
erysipelas  is  inflammation  of  the  skin  (and  con- 
nective tissue  beneath  it),  and  as  it  is  accompanied 
by  the  growth  of  a  micro-organism,  it  is  a  "  specific 
inflammation  "  of  the  skin.  Now  the  redness  ot  the 
skin  being  attributed  to  an  excess  of  food,  and  being 
treated  by  restriction  of  the  diet,  it  may  seem 
somewhat  strange  to  attribute  the  extreme  pallour 
which  we  find  in  anaemia  {triphthcemia  or 
catatrihcemia)  to  the  same  cause,  viz.,  an  excess  of 
food,  and  generally  an  excess  of  starch  and  sugar, 
I  hope,  however,  that  the  reader  is  now  accustomed 
to  the  idea  that  defect  and  excess  of  function  are 
often  due  to  the  same  cause.  I  should,  however, 
like  to  add  a  word  or  two  here  to  shew  how  excess 
of  food  so  frequently  acts  in  causing  the  pallour  of 
anaemia.  In  anaemia  the  muscular  fibres  of  the 
vessels,  and  particularly  their  transverse  or  circular 
fibres,  are  first  hypertrophied,  as  it  is  called,  or 
overgrown.  When  they  are  overgrown,  they  tend 
to  go  into  contraction,  and  the  efiect  of  this  being 
to  diminish  the  calibre  of  the  vessels,  less  blood  gets 
into  it,  and  pallour  of  the  skin,  if  the  vessels   in 


485 

question  are  skin-vessels,  results.  But  the  muscular 
fibres  of  the  vessels  become  hypertrophied  because 
the  blood  contains  in  it  more  material  than  it 
requires  for  the  effective  nourishment  of  the  tissues. 
The  pallour  or  anaemia  is  therefore  a  direct  effect  of 
the  over-nutrition  of  the  fibres  which  automatically 
act  so  as  by  cutting  off  the  blood- supply  to  diminish 
their  over-growth.  But  inasmuch  as  relaxation 
always  follows  contraction,  and  is  further  apt  to  be 
proportional  to  it,  the  greater  the  contraction  the 
greater  the  subsequent  dilatation,  the  same  causes 
which  primarily  produce  the  pallour  of  anaemia 
secondarily  produce  the  over-redness  of  erysipelas ; 
and  by  observation  and  interpretation  of  these 
processes  we  see  how  the  same  cause,  viz.  an  excess 
of  nutritive  material  in  the  blood,  produces  both  of 
these  opposite  states.  The  same  reasoning  enables 
us  to  understand,  when  the  necessary  name  changes 
are  made,  how  over-nutrition  by  causing  hypertrophy 
of  the  transverse  muscular  fibres  of  the  bowel  may 
induce  constipation,  and  then  when  dilatation 
follows,  may  induce  diarrhoea.  And  the  practical 
conclusion,  of  supreme  importance  to  right  treat- 
ment, follows,  that  in  order  to  cure  the  pallour  of 
anaemia  and  also  the  too  great  redness  of  erysipelas,  we 
must  restrict  the  diet  ;  while  it  also  follows  that  in 
order  to  cure  constipation  and  its  opposite,  diarrhoea, 
we  must  restrict  the  diet  likewise.  These  opposite 
conditions  are  not  usually  found  both  to  be  present 
in  the  same  person  at  near  periods  of  time — they 
cannot,  of  course,  both    be    present    in    the  same 


i86 

person  at  the  same  time — hence  our  rule  or  canon 
of  treatment  generally  takes  the  form  of  compelling 
us  to  treat  pallour  in  A  by  the  same  means  by 
which  we  treat  over-redness  or  erysipelas  in  B, 
viz.,  by  restriction  of  the  diet.  And  the  same 
considerations  apply,  mutatis  mutandis,  to  the 
treatment  of  constipation  and  diarrhoea.  Never- 
theless, as  even  in  the  same  person  anaemia  may  be 
present  at  one  stage  of  illness  and  erysipelas  at 
another,  and  the  same  being  true  of  constipation 
and  diarrhoea,  it  follows,  or  may  follow,  that  we  may 
have  to  treat  even  in  the  same  person,  at  somewhat 
longish  intervals  of  time,  opposite  states  in  the  same 
way,  viz.,  by  restriction  of  the  diet. 

Other  skin  affections  which  are  due  to  over 
nutrition,  and  particularly  to  over  ingestion  into  the 
economy  of  starch  and  sugar  (not  necessarily,  be  it 
always  remembered,  unwholesome  food),  are  eczaema 
and  pruritus,  or  excessive  itchiness  of  the  skin.  A 
very  annoying  form  of  this  latter  affection  is 
frequently  experienced  at  that  part  of  the  skin 
which  lies  close  to  the  orifice  of  the  bowel  and  is 
called  pruritus  ani.  In  this  affection  patients 
scratch  themselves  till  they  bleed,  doing  it  often 
even  in  their  sleep,  and  waking  themselves  up  in 
great  misery.  Many  remedies  have  been  suggested 
for  its  relief,  and  some  of  them  are  useful ;  but  the 
great  remedy  is  restriction  of  the  diet,  and  usually 
restriction  of  the  carbonaceous  elements  in  the  diet. 
I  detailed  a  case  in  the  first  edition  of  this  essay, 
and  I  repeat  it  here.     A  stout  woman,  aged  41,  who 


487 

had  suffered  from  this  complaint  for  a  long  time, 
presented  herself  as  an  out-patient  at  the  Bradford 
Infirmary  in  August,  1896.  She  had  suffered  from 
time  to  time,  for  no  less  than  seventeen  years  from 
the  intolerable  itching  which  characterises  this 
affection,  and  had  sought  advice  and  assistance  from 
several  quarters,  though  without  obtaining  relief 
She  used  to  suffer  from  diarrhoea  (due,  no  doubt,  to 
fermentation  of  carbonaceous  food)  but  this  had 
subsided  of  itself  before  she  came  under  my  care. 
She  had  been  subject  also  to  attacks  of  "influenza 
colds  "  from  time  to  time,  that  is,  had  attacks  of 
sneezing  with  cough,  but  had  never  been  laid  up 
with  bronchitis  proper.  When  I  saw  her  she  had 
very  disturbed  nights,  on  account  of  the  itching, 
which  made  her  scratch  herself  in  her  sleep,  some- 
times till  blood  was  drawn.  By  the  simple  advice 
of  recommending  her  to  take  bread  only  once  a  day, 
and  greatly  diminishing  other  forms  of  carbonaceous 
foods,  I  was  able  entirely  to  relieve  this  long- 
standing ailment,  so  that  in  about  five  weeks  from 
the  time  of  her  coming  under  treatment  she  was 
able  to  sleep  right  through  the  night.  In  another 
fortnight  all  the  eczsematous  spots  (I  suppose 
pruritus  ani  really  is  eczaema  ?)  had  healed. 

There  now  occurred  a  rather  remarkable 
incident.  For  some  time  I  lost  sight  of  the  patient, 
who  absented  herself  from  the  out-patient  room 
from  the  end  of  December,  1896,  tiU  February, 
1897,  when  she  was  nearly  as  bad  as  ever  again. 
What  was  the  reason  of  this  relapse  ?     She  told  me 


488 

she  had  had  a  miscarriage,  and  had  been  obliged  to 
consult  a  medical  man.  He  had  put  her  on  the 
conventional  treatment  usually  adopted  in  that 
condition,  ordering  her  to  live  on  gruel,  bread  and 
milk,  rice  and  milk,  &c.  The  increase  of  starch 
taken  brought  back  the  itching,  and  she  was  obliged 
to  make  her  way  back  to  the  Infirmary  as  soon  as 
possible  to  obtain  relief  again,  in  which  she  was 
not  disappointed.  Here,  then,  is  a  case  in  which 
a  medical  man — first,  alleges  that  the  main  cause  of 
an  ailment  lasting  for  seventeen  years  is  wrong 
eating  (and  particularly  that  it  is  eating  too  much 
bread  and  carbonaceous  food) ;  second,  in  which  he 
therefore  recommends  that  bread  be  taken  only  once 
a  day.  Thirdly,  the  patient  recovers,  or  practically 
recovers  (she  was  not  perfectly  well)  on  taking  his 
advice.  Fourthly,  she  is  compelled  to  put  herself 
under  advice  for  another  ailment ;  and  for  the 
management  of  that  ailment  is  recommended  to  live 
on  the  kind  of  food  which  was  alleged  to  be  the 
main  predisposing  cause  of  her  first  ailment. 
Fifthly,  the  first  ailment  returns  in  accordance  with 
the  original  statement.  Sixthly,  the  ailment  again 
disappears  when  she  again  follows  the  original 
advice.  I  do  not  know  what  more  clinical  evidence 
could  be  demanded  by  the  most  sceptical  in  the  way 
of  a  demonstration  as  to  what  the  causes  of  the 
ailment  were.  The  logical  methods  of  agreement 
and  difference  combine  to  demonstrate  that  the 
main  predisposing  cause  of  pruritus  ani  is  wrong 
eating,  and  in  particular  that  it  is  the  consumption 


489 

in  excess  of  starchy  food.  She  suffers  from  the 
aihnent  when  she  takes  the  food,  and  she  ceases  to 
suffer  when  she  ceases  to  take  it ;  or  rather  (since 
it  is  not  abstinence  but  moderation  which  is 
inculcated  by  nature)  when  she  sufficiently 
diminishes  it.  Now  this  conclusion  does  not  apply 
to  this  case  only,  but  to  practically  all  cases  where 
the  experiment  is  made.  The  conclusion  that  the 
alleged  cause  is  really  the  main  cause  has  become 
firmly  fixed  in  my  mind,  and  has  indeed  the  force  of 
a  law  of  nature  or  of  human  organisation.  And, 
of  course,  anyone  can  for  himself  put  the  law  into 
action  when  appropriate  circumstances  arise. 

There  is,  however,  a  further  line  of  evidence 
possible,  in  order  to  prove  this  conclusion  up  to  the 
hilt.  If,  as  I  suggest,  starch  and  sugar  is  the  cause 
oi  pruritus  ani,  how  does  starch  and  sugar  cause  it  ? 
Perhaps  by  carrying  into  the  stomach  and  thence 
into  the  intestines,  and  thence  again  into  the  blood, 
some  spore  or  seed  which  grows  by  preference  at 
the  orifice  of  the  bowel  ?  Might  it  not  be  possible 
to  demonstrate  the  existence  of  this  spore  first  in 
the  starch  granules  of  the  food,  and  second,  in  the 
blood?  Such  spores  when  in  small  numbers  are 
no  doubt  destroyed  by  the  digestive  juices,  but  it  is 
conceivable  that,  if  ingested  in  too  large  numbers, 
that  is,  when  too  much  of  the  food  containing  them 
is  consumed,  they  may  escape  digestion,  and  find 
their  way  into  the  blood,  and  so  be  carried  to  their 
favourite  site.  Of  course  this  is  a  mere  suggestion, 
but  it  does  not  seem  at  all  an  impossible  means  by 


490 

which  the  disease  may  be  conveyed,  although  there 
is  no  proof  up  to  the  present  time  that  pruritus  ajti 
depends  upon  bacteriological  growth  at  all. 

Cases  of  this  kind  could  be  multiplied  to 
weariness.  Indeed  some  critics  seem  to  complain 
of  the  nauseousness  of  the  proof  of  the  dependence 
of  disease  on  wrong  eating.  But  what  can  one  do  ? 
If  one  says  that  such  is  the  case,  and  that  the 
taking  of  too  much  food  is  the  chief  predisposing 
cause  of  the  large  majority  of  the  ailments  to 
which  humanity  is  subject,  one  is  asked  for  proof. 
It  is  a  perfectly  reasonable  request,  and  ought  to  be 
met.  But  when  it  is  met,  it  is  rather  unfair  that 
one  should  be  twitted  with  the  reproach  that  the 
proof  is  excessive  and  wearisome. 

Sycosis.  A  very  chronic  and  intractable  form  of 
skin  disease  is  one  which  attacks  the  chin  and  cheeks 
and  upper  lip  in  men,  and  is  often  said  to  be  induced 
by  the  use  of  dirty  instruments  at  barbers'  shops. 
It  is  called  acne  mentagra  (acne  of  the  chin),  or 
sycosis  mentij  and  consists  of  a  number  of  pustular 
points,  suppurating,  itching,  and  unsightly,  affecting 
the  chin  or  upper  lip  or  cheeks.  It  is  of  two  forms, 
and  is  known  to  be  due  to  the  growth  of  a  parasite, 
either  the  Tinea  Barbae  or  the  Staphylococcus 
aureus  et  alhus.  This  is  the  authoritative  state- 
ment, although  I  regret  to  be  unable  to  accept  it  in 
this  form  from  what  I  am  about  to  add.  I  think  it 
is  a  much  truer  statement  to  say  that  the  disease 
is  known  to  be  associated  with  the  growth 
and    development    of    the     Tinea    Barbae    or    the 


491 

staphylococcus  aureus  et  albus,  than  to  say  it  is 
due  to  it.  The  treatment  recommended  is  usually 
painful  and  long,  and  consists  in  epillating  or 
removing  the  affected  hairs  with  pincers,  and  in 
the  free  application  of  germicide  ointments,  &c.,  &c., 
and  the  treatment  is  admitted  to  be  "  unsatis- 
factory." I  am  sorry  to  add  what  I  have  to  say, 
because  it  seems  to  conflict  so  much  with  ordinary 
views  ;  but  I  find  this  one  of  the  easiest  affections 
to  treat,  and  one  which  does  not  require  any  long 
time  either,  not  longer  than  say  eight  or  ten  weeks, 
if  the  simple  plan  is  had  recourse  to  of  restricting  the 
diet.  A  young  man,  who  suffered  long  and  greatly 
from  this  affection  of  the  skin  and  cheeks,  affecting 
the  hair  follicles  of  beard  and  whiskers,  was  easily 
and  painlessly  cured  by  the  simple  device  of 
stopping  his  breakfast,  otherwise,  by  putting  him 
on  two  meals  a  day.  I  thought  the  case  so 
interesting  that  I  asked  the  youth  to  report  himself 
to  a  senior  colleague  of  mine,  a  former  hospital 
surgeon,  who  corroborated  the  diagnosis  and  con- 
curred in  admitting  the  efficacy  of  the  treatment. 
The  rationale  is  again  quite  simple.  There  is  no 
difficulty  about  it.  Too  abundant  eating  does  not 
(probably)  cause  or  create  the  growth  of  the 
parasite  which  is  associated  with  the  disease 
(although  the  spores  of  it  may  be  swallowed  in 
food  or  drink,  and,  being  ingested  in  great  excess, 
may  escape  or  elude  the  activity  of  the  digestive 
juices).  But,  however  the  parasite  got  into  the 
economy,  there  it  is ;  and  the  question  is  whether 


492 

is  It  better  (a)  to  attack  it  directly  by  attempting 
to  extract  it  or  weed  it  out,  so  to  say  ;  or  (b)  to  kill 
it  by  making  the  soil  in  which  it  grows  unsuitable 
to  harbour  it  ?  As  I  believe  the  disease  to  consist 
not  by  any  means  so  much  in  the  presence  of  the 
parasite  as  in  the  state  or  condition  of  the  soil  in 
which  it  grows,  that  is  to  say,  the  state  of  the  body 
and  tissues,  it  follows  that  our  efforts  at  treatment 
ought  to  take  the  line  not  of  up- rooting  the 
parasite,  but  in  attempts  to  render  the  body 
unsuitable  to  harbour  it.  The  line  of  treatment  is 
determined  by  the  analogy  so  often  referred  to  now 
that  an  over-fed  body  is  like  an  over-manured  soil, 
and  as  the  latter  tends  to  grow  noxious  weeds,  so 
the  former  tends  to  harbour  the  growth  of  parasites. 
Make  the  soil  sound  by  proper  drainage  and  proper 
manuring,  and  suitable  crops  will  be  produced ; 
make  the  body  healthy  by  proper  feeding,  and 
drain  away  impurities  by  restriction  of  the  diet,  so 
that  any  excess  of  pabulum  shall  be  used  by  the 
body,  oxidised  and  converted  into  the  heat  and 
motion  of  life ;  and  then  the  parasite,  finding  the 
conditions  no  longer  suitable  for  it,  will  die,  acne 
spots  will  heal,  and  diseases  like  sycosis  menti  will 
disappear.  The  reader  will  not  fail  to  see  that  the 
principles  underlying  the  management  of  this 
affection  are  exactly  the  same  as  those  already 
discussed  when  we  were  considering  the  nature  of 
fever  and  of  tuberculosis.  Well  might  Asclepiades 
of  Prusa,  the  medical  adviser  of  Cicero  say,  Mr) 
o     TTvpeTo^,     dXXa     to     nvperelv,     non     fehris     sed 


493 

fehricitare — "the  important  things  for  doctor  and 
patient  to  consider  and  weigh  are  not  whether  the 
patient  has  scarlet  fever,  or  diphtheria,  or  influenza, 
or  small-pox,  but  the  fact  that  he  has  a  fever  at  aU." 
And  he  might  have  added,  as  he  would  no  doubt 
have  added  had  he  lived  to-day ;  the  important 
thing  to  be  considered  by  him  who  has  sycosis 
menti,  or  by  the  doctor  who  would  treat  him 
skilfully,  so  as  to  prevent,  for  instance,  the  dis- 
figuring keloid  which  is  so  apt  to  mark  the  face  of 
those  in  whom  the  disease  has  run  an  unchecked 
course,  is  not  that  sycosis  is  caused  by  a  parasite,  but 
that  a  parasite  of  any  kind  should  be  thriving  in 
the  body  at  all.  And  even  if  a  man  thinks  he  got 
or  caught  his  sycosis  at  the  barber's,  it  will  be  well 
for  him  to  inquire  how  it  happened  that  so  small  a 
cause  induced  in  him  so  loathsome  an  affection  ;  as 
also  to  inquire  how  he  may  most  readily  in  future 
make  himself  immune  to  such  influences. 

I  ought  to  add,  before  leaving  the  subject  of 
the  skin  and  skin  affections,  that  the  skin  behaves 
as  other  tissues  and  parts  of  the  body  do,  and  that 
the  circulation  in  it  is  disturbed  in  the  three 
directions  of  excess  of  circulation,  of  defect  of 
circulation,  and  of  irregularity  of  circulation,  by 
excess  of  irritation,  the  commonest  form  of  which  is 
excess  of  food.  The  reader  will  therefore  be 
prepared  to  draw  for  himself  the  conclusion  that  if 
the  skin  is  too  moist  on  the  one  hand,  or  too  dry  on 
the  other,  if  it  is  too  hot  or  too  cold,  or  if  too  much 
moisture    alternates    too    rapidly    with   too   much 


494 

dryness,  or  too  much  hotness  with  too  much 
coldness,  we  should  in  all  cases  look  for  a  constant 
irritation  ;  and  nine  times  out  of  ten,  or  at  least 
three  times  out  of  four,  we  shall  find  that  that 
constant  or  frequently  acting  irritation  is  too 
abundant  or  too  frequent  feeding.  Even  loss  of 
hair,  as  shewing  such  congestion  of  skin  as  cuts  off 
its  own  blood  supply,  so  killing  the  hair  follicles, 
has  often  to  be  treated  by  restriction  of  the  diet. 
The  occurrence  of  keloid  or  the  white  shiny  state 
of  skin  left  hke  the  scar  of  a  burn  after  sycosis  has 
been  cured  by  destructive  inflammation,  shews  the 
condition  of  skin  to  which  in  some  cases  complete 
and  permanent  loss  of  hair  is  due. 

As  I  have  been  referring  to  the  skin  and  hair, 
perhaps  this  will  be  the  best  place  in  which  to  treat 
of  ulceration.  The  term  ulceration  is  applied  to 
death  of  a  portion  of  any  surface  of  the  body,  and 
most  usually  to  death  of  a  portion  of  the  outer 
surface  of  the  body  or  skin,  although,  of  course,  it 
may  refer  to  death  of  a  portion  of  an  inner  surface, 
as  the  mucous  membrane,  lining  the  intestines  or 
stomach  or  lungs.  Wherever  it  is  found,  the  same 
principles  underlie  both  the  mode  of  its  occurrence, 
and,  therefore,  its  proper  treatment.  Ulceration, 
like  most  (or  all  ?)  other  diseases,  may  be  due  to 
one  of  two  opposite  causes,  starvation  and  plethora, 
or,  as  we  have  now  learned  to  call  them,  direct  and 
indirect  starvation.  The  former  form  we  very 
rarely  see,  although  we  often  think  we  see  it.  But 
if  an  animal  is  literally  starved  to  death,  it  suffers 


495 

from  various  forms  of  ulceration  before  it  expires. 
It  may  suffer  from  ulceration  of  the  skin,  of  the  eye 
(sloughing  of  the  cornea),  or  of  some  mucous 
surface.  Of  course,  this  form  of  ulceration  must 
be  treated  by  cautious  increase  of  the  diet,  and  if, 
for  example,  men  had  been  exposed  in  a  boat  fifty 
days  with  ten  days  provisions  on  board ;  or  if 
miners,  being  entombed  by  accident  for  a  similar 
length  of  time,  were  found  to  be  suffering  from 
various  forms  of  ulceration,  it  would  be  necessary  to 
cautiously  feed  them  with  an  increasing  amount  of 
nutriment  in  order  to  cure  it.  But  how  rarely  do 
we  see  this.  One  of  the  commonest  forms  of 
ulceration  is  the  callous  ulcer,  as  it  is  called,  very 
often  appearing  as  a  large  ulcerated  surface  on  the 
leg,  surrounded  by  a  raised  thickened  mass  of 
connective  tissue  an  inch  or  two  inches  broad,  and 
an  apparent  three-eighths  of  an  inch  thick,  and 
very  often  accompanied  by  thickening  of  the  vein- 
coats  also.  These  last,  as  they  are  weakened  and 
inelastic  as  well  as  thickened,  are  very  apt  to  give 
way  and  cause  dangerous  haemorrhage,  as  is  well 
known,  in  this  kind  of  ulcer.  The  thickening  of 
connective  tissues  and  of  the  vein-coats  is  very  well 
calculated  to  suggest  to  the  mind  of  the  reflective 
observer  what  the  real  cause  of  the  disease  is,  for 
how  can  thickening  or  over-growth  arise  without 
over-nutrition  ?  or,  at  least,  what  cause  is  so  likely 
to  produce  it  as  over-feeding  ?  Accordingly  it  is 
found  that  restriction  of  the  diet  has  a  very 
beneficial  influence  on  this  form  of  disease.     Very 


496 

few  callous  ulcers  of  the  leg  indeed,  with  or  without 
the  accompaniment  of  varicosity  of  the  veins, 
would  fail  to  be  greatly  benefited,  and  many  would 
be  cured,  by  a  fast  of  six  weeks  or  so.  A  woman 
of  63  years  of  age  whom  I  treated  in  this  way,  or 
by  putting  her  on  a  pint  of  milk  and  half  a  pint  of 
mutton-  or  beef-tea  daily  for  six  weeks  (a  greatly 
restricted  diet,  of  course)  was  so  much  benefited 
that  her  ulcer  of  the  leg  of  many  years  standing 
has  never  since  that  time  given  her  any  serious 
trouble.  There  is,  in  fact,  nothing  original  in  such 
a  method  of  treatment,  although  it  is  not  so  often 
recommended  as  it  ought  to  be,  for  in  ulcer  of  the 
stomach  patients  are  either  put  on  a  very  little  thin 
barley  water  or  on  say  an  ounce  of  milk  and  water 
every  hour  or  every  two  hours  during  the  day,  and 
on  a  little  water  if  they  are  thirsty  during  the 
night.  But  an  ounce  of  milk  and  water  every  hour 
from  eight  in  the  morning  till  nine  at  night  is  only 
14  half-ounces,  or  seven  ounces,  of  milk  in  24  hours, 
less  than  half  a  pint;  and  even  14  ounces  of  milk 
if  undiluted  milk  were  ordered  (but  if  this  were  so 
it  would  probably  be  ordered  not  every  hour  but 
every  two  hours)  would  be  a  very  restricted  diet, 
which  might,  even  without  much  strain  on 
language,  be  called  a  starvation  diet.  Yet  it  is 
an  excellent  diet  for  ulceration  of  the  stomach, 
and  is  very  often  prescribed  by  medical  men.  The 
same  treatment  is  not  so  often  resorted  to  for 
callous  ulcer ;  but  obviously  the  causes  of  its 
formation  are  the  same,  and  it  ought,  therefore,  to 


497 

be  amenable  to  the  same  treatment,  as  in  fact  it  is 
found  to  be  by  whoever  has  the  courage  to  put  it  to 
the  test.  The  reader  may  perhaps  demur  to  the 
treatment  of  strumous  or  scrofulous  ulceration  by 
this  means,  but  I  have  already  mentioned  the  case 
of  a  child  of  four  years  old  in  whom  I  treated  a 
strumous  ulceration  and  suppuration  of  the  knee  by 
a  greatly  restricted  diet,  and  this  with  perfect 
success,  the  child  gaining  about  10  lbs.  in  weight  in 
the  course  of  15  months.  This  was  a  case  of 
juvenile  struma.  Senile  struma  is  also,  I  am 
convinced,  much  more  amenable  to  a  treatment  by 
restriction  than  to  the  treatment  usually  recom- 
mended for  it,  viz.,  increase  of  the  diet,  as  the 
following  case  will  shew.  A  gentleman  of  58  years 
of  age,  who,  to  use  popular  language,  might  be 
described  as  being  riddled  with  strumous  ulceration, 
affecting  his  back,  groin,  leg  and  arm,  and  who  had 
undergone  surgical  treatment  at  the  hands  of  a 
most  distinguished  surgeon  without  much,  if  any, 
benefit  to  his  ulceration,  had  his  wounds  healed  and 
his  system  strengthened  by  restricting  his  diet  to 
practically  one  meal  a  day,  continued  for  over  a 
year.  Another  man,  in  the  prime  of  life,  who 
suffered  year  after  year  from  suppuration  of  the 
glands  of  his  neck,  was  entirely  cured,  and  that 
without  recurrence,  by  two  meals  a  day.  This  last 
was  a  fine  well-made  man,  about  5  ft.  10  ins.  in 
height,  and  weighing  about  186  lbs.,  who  might 
therefore  be  supposed,  and  generally  is  supposed,  to 
require  a  quantity  of  food  larger  than  the  average, 

FF 


498 

in  order  to  keep  up  his  frame  and  strength.  Never- 
theless, by  reducing  his  usual  three  daily  meals, 
and  occasionally  four,  down  to  two  a  day,  his 
ulceration  was  quite  healed,  and  has  not  recurred. 

The  following  case  is  illustrative  of  the 
beneficial  action  of  the  same  principles.  It  was 
a  case  of  (probably)  ulceration  of  the  large 
intestine.  A  woman,  54  years  of  age,  ansemic, 
and  whose  appearance  suggested  even  the  idea  that 
she  might  be  suffering  from  pernicious  anaemia,  or 
some  other  possibly  malignant  affection,  came  into 
the  Bradford  Royal  Infirmary  suffering  from 
frequently  recurring  loss  of  blood  per  rectum.  The 
quantities  lost  amounted  to  about  eight  ounces  at  a 
time,  dark  liquid  blood  for  the  most  part,  with  a 
few  clots.  The  site  of  the  bleeding  could  not  be 
discovered.  She  had  been  under  treatment  for 
some  time,  but,  beyond  a  diagnosis  of  ulceration, 
of  probably  the  large  intestine,  a  diagnosis  which  I 
believe  to  have  been  perfectly  correct,  nothing 
further  could  be  said  about  it,  and  she  had  not 
improved.  The  source  of  the  haemorrhage  might 
have  been  in  the  rectum,  although  the  finger  could 
not  detect  it,  but  probably  was  higher  up  in  the 
colon.  Of  course  it  might  have  been  higher  up 
still  in  the  ileum.  In  any  case,  here  was 
haemorrhage  recurring  in  a  thin,  wasted,  attenuated 
woman,  and,  evidently,  unless  it  was  checked,  it 
must  prove  too  much  for  the  patient.  To  cut  down 
on  the  bowel,  first  opening  the  abdomen  and  then 
the  gut,   on  the  chance  of  finding   the  spot  from 


499 

which  the  hsemorrhage  came,  and  of  excising  the 
ulcer,  if  one  was  found,  seemed  a  very  haphazard 
proceeding.  If  the  surgeon  failed  in  one  place,  he 
would  have  to  stitch  up  his  opening,  and  proceed  to 
another  attempt  to  find  the  bleeding-point.  If  his 
second  attempt  failed,  he  would  have  to  make  a 
third,  a  fourth,  a  fifth,  and  even  an  indefinite 
number  of  attempts  to  find  the  source  of  the 
haemorrhage  along  a  portion  of  bowel  measuring 
eight  feet  long,  even  if  it  was  in  the  large  intestine, 
which  was  by  no  means  certain.  There  can  be  little 
doubt  that  such  a  set  of  proceedings  would  have 
most  probably  cost  the  patient  her  life.  Although, 
therefore,  she  came  into  hospital  for  operation,  I 
refused  to  operate.  The  sequel  is  very  interesting. 
Under  a  diet  of  half  a  pint  of  milk  twice  a  day, 
and  a  little  soup  in  the  middle  of  the  day,  continued 
for  six  weeks,  this  patient  made  a  gradual  and 
finally  a  complete  recovery.  The  quantity  of  blood 
lost  fell  at  about  the  third  week  of  treatment  to 
six  ounces,  later  to  four  ounces,  later  to  about  two 
ounces,  and  finally  ceased.  The  intervals  at  which 
the  bleedings  occurred  gradually  lengthening 
between  the  attacks  as  the  quantity  of  the 
haemorrhage  diminished,  plainly  showed  also  that 
the  ulceration  was  gradually  healing ;  and  although 
we  did  not  see  the  process  going  on,  and  did  not 
even  know  exactly  where  it  was,  it  was  very  easy 
to  compare  the  healing  of  external  ulceration  which 
one  had  often  seen,  with  the  steps  of  the  process 
which  were  occurring  somewhere  in  the  bowel,  and 


500 

I  do  not  now  believe  that  our  imagination  was 
incompatible  with  the  facts.  The  patient  was 
recommended  to  eat  only  twice  a  day  for  the  rest 
of  her  life,  and  when  she  left  the  hospital  was  quite 
well,  the  gray,  ashy  colour  of  her  face  being  con- 
siderably improved.  No  doubt,  if  she  does  as  she 
has  been  advised,  or,  if  necessary,  eats  only  once  a 
day,  she  will  recover  even  more  than  she  has  yet 
done. 

The  result  of  this  case  confirms  me  in  the 
general  view  that  ulceration  is  caused  by  starvation 
of  tissue  due  to  previous  hypertrophy,  and  that 
hypertrophy,  wherever  found,  is  generally  due  to 
over-feeding.  Of  course,  ulceration  may  be  due  to 
direct  starvation,  but  this  happens  so  rarely  in 
civilised  life,  that  we  may  practically  throw  it  out 
of  account.  Practically  it  is  almost  always  due  to 
indirect  starvation,  not  to  direct.  A  sensible  doctor 
will  inquire  which  of  the  two  opposite  causes  is  at 
work,  and  will  act  accordingly,  treating  the  efi'ects 
of  direct  starvation  by  cautious  increase,  and  those 
of  indirect  starvation  by  cautious  restriction  of  the 
diet.  The  explanation  of  the  mode  or  method  of 
causation  determines  the  mode  or  method  of  treat- 
ment, and  seems  to  me  to  have  been  the  same,  in  the 
case  detailed,  as  has  been  described  now  more  than 
once.  The  essential  cause  was  too  frequent  and  too 
abundant  feeding  (pollaki-siteism  and  poly-siteism). 
The  accidental  cause  was  too  much  bread  and  butter 
and  tea,  which  formed  the  main  part  of  the  diet 
(pollaki-amylism  and  poly-amylism).      Through  too 


501 

frequent  and  too  abundant  feeding,  first  over- 
nutrition  and  then  starvation  through  blocking  of 
its  circulation,  took  place  at  some  unknown  point  in 
the  gut.  Ulceration  followed,  which  opened  a  vessel 
or  vessels,  so  causing  the  haemorrhage.  Under 
restriction  of  the  diet,  the  exudation  into  the 
surrounding  tissues  was  gradually  removed,  and  the 
circulation  in  the  place,  wherever  it  was,  gradually 
became  re-estabhshed.  By  this  means  the  ulcera- 
tion was  healed  and  the  bleeding  ceased,  the 
gradual  diminution  of  the  quantities  of  blood 
thrown  out  coinciding  with  lengthening  of  the 
intervals  between  the  attacks.  For  let  us  look  at 
the  argument.  If  too  abundant  feeding,  and  in 
women  too  frequent  feeding  (for  how  often  do 
women  eat  because  they  are  ' '  faint  " — not  much  at 
a  time,  but  a  little  food  and  often  !),  is  the  cause  of 
hypertrophy  and  exudation ;  if  the  exudation  has  a 
low  vitahty  and  dies,  leaving  a  raw  place,  otherwise 
an  ulcer — if  these  things  are  so,  then  it  follows  that 
restriction  of  the  diet,  or  even  starvation,  will 
gradually  remove  the  blocking  of  the  circulation, 
which  is  only  another  name  for  exudation.  In  the 
case  in  question,  restriction  of  the  diet  was  followed 
by  healing  of  the  ulceration,  or  was,  at  least, 
followed  by  cessation  of  the  haemorrhage,  which 
was  probably  due  to  ulceration.  Will  not  any 
sensible  man,  who  realises  the  force  of  the  steps  of 
this  argument,  and  who  realises  besides  the  happy 
results  of  the  treatment  founded  on  the  argument, 
be  confirmed  in  his  belief  of  the   soundness   of  his 


502 

general  conclusion,  and  be  induced,  therefore,  to  put 
into  operation  a  similar  chain  of  argument,  should 
any  similar  case  again  come  before  him,  and  to 
follow  it  up  by  similar  treatment  ?  It  is  probable 
evidence,  no  doubt,  not  demonstrative,  but  it  is  the 
kind  of  evidence  on  which  we  act  in  conducting  the 
practical  business  of  life,  and  is  quite  sufficient  for 
the  successful  conduct  of  that  business  by  sensible 
persons.  In  accordance  with  such  evidence  juries 
and  judges  give  verdicts  which,  if  they  are  wrong 
occasionally,  are  usually  correct,  and  give,  on  the 
whole,  satisfaction  to  the  public. 

The  uncertainty  and  flightiness  of  mental 
condition  which  so  often  accompanies  the  lymph 
congestion  of  the  connective  tissue  of  the  brain  and 
nervous  system,  and  which,  when  aggravated,  not 
infrequently  sends  women  to  asylums,  is  often 
accompanied  by  a  sign  on  which  I  wish  to  say  a  few 
words.  I  mean  dilatation  of  the  pupils.  Dilatation 
(like  all  ?  other  signs)  may  be  due  to  two  opposite 
states,  to  stimulation  of  one  set  of  nerves,  the 
cranial,  or  to  paralysis  of  another,  the  sympathetic. 
When  a  person  becomes  comatose  with  a  serous 
effusion  on  the  brain,  his  pupils  are  usually  widely 
dilated.  That  is  because  both  sets  of  nerves,  the 
cranial  and  the  sympathetic,  but  particularly  the 
latter,  are  paralysed  or  have  lost  their  power,  The 
transverse  elements  of  the  pupils  are  governed  by 
a  cranial  nerve  (the  third),  while  the  circular  fibres 
are  under  the  control  of  the  sympathetic.  Stimu- 
lation of  the   former,   therefore,  dilates  the   pupil, 


503 

while  stimulation  of  the  latter  contracts  it ;  and  of 
course,  complete  paralysis  of  both,  by  relaxing  both, 
causes  the  dilatation  that  threatens,  if  it  does  not 
necessitate  death.  Now  in  the  flighty  and  uncertain 
state  of  mind  to  which  I  am  referring — it  is  often 
called  brain-fag — when  the  connective  tissue  of  the 
brain  is  congested  with  lymph  (when  cerebral  initis 
is  present),  there  is  also  very  often  present  initis  of 
the  third  cranial  nerve,  and  hence  over-stimulation 
of  the  same,  and  of  the  fibres  in  the  iris  which  it 
supplies,  with  consequent  dilatation  of  the  pupils. 
Sometimes  this  expresses  itself  in  headache  rather 
than  in  mental  disturbance,  but  however  brought 
about,  excessive  pupil  dilatation  ought  to  attract 
our  attention,  as  it  is  a  sign  that  there  is  too  much 
lymph  about  the  base  of  the  brain,  too  much  lymph 
depending  on  too  much  or  too  rich  blood,  and  too 
rich  blood  depending  on  too  much  food.  Sometimes, 
indeed,  this  condition  leads  to  defects  of  vision  in 
young  people,  the  proper  remedy  for  which  is  rather 
to  recommend  a  restriction  of  the  diet,  than  to  try 
to  find  spectacles  which  will  overcome  the  defect. 
I  have  several  times  in  fact  been  able  to  overcome 
visual  defects,  especially  in  children,  by  altering 
their  diet,  the  visual  defect  being  rather  the  local 
manifestation  of  a  general  condition  than  the 
substantive  affection.  In  children  the  sign  often 
accompanies  a  too  slow  pulse  (48  or  50,  e.g.),  and 
both  the  slowness  of  the  pulse  and  the  dilatation  of 
the  pupils  are  to  be  met  by  restriction  of  the  diet, 
as  in  fact  both  have  been  caused  by  excess  of  food. 


504 

In  young  neurotic  women  also  we  frequently  find 
dilatation  of  the  pupils,  although  the  pulse  may  not 
be  disturbed,  or,  if  it  is,  it  may  be  too  quick  rather 
than  too  slow.  The  sign  is  not  so  often  found  in 
men,  although  the  slow  pulse  often  is.  I  can  only 
explain  this  by  saying  that,  as  a  rule,  men  have  a 
greater  resistance  than  either  women  or  children, 
although  no  one  knows  better  than  I  that  this  is  no 
explanation,  and  that  it  is  merely  a  statement  of 
the  fact  in  another  form.  However,  I  think  it  is  a 
fact.  What,  however,  I  wish  to  draw  attention  to 
is  the  highly  important  practical  conclusion  that 
dilatation  of  the  pupils  (whether  accompanied  or 
not  by  the  changes  in  the  pulse  rate  referred  to)  is 
best  combated  and  ought  to  be  combated  by 
restriction  of  the  diet.  And  I  have  to  add  that  in 
a  few  weeks  (two  to  six,  for  unfortunately  it  takes 
a  rather  long  time),  under  a  restricted  diet  say  of  a 
pint  of  milk  daily,  divided  into  small  quantities  at 
intervals,  these  dilated  pupils  can  be  restored  to 
their  normal  state.  I  could  give  cases  in  which 
this  sort  of  management  has  been  quite  successful, 
but  space  forbids. 

There  is,  however,  an  important  disease  in 
which  this  sign  of  over-dilatation  of  the  pupils  is 
frequently  present,  on  which  I  wish  to  say  a  few 
words,  and  that  is  epilepsy.  I  have  seen  first  and 
last  a  good  many  cases  of  epilepsy,  and  have  come 
to  have  a  strong  opinion  that  its  causes  also  are 
chiefly  wrong  feeding,  and  particularly  too  abundant 
feeding,  acting  upon  a  low  resistance  to  digestive 


506 

labour.  It  is  very  difficult,  no  doubt,  to  prove  the 
truth  of  this  view  or  of  any  view,  in  the  case  of 
epilepsy,  for  this  reason  :  Epilepsy  has  a  very 
varying  and  variable  periodicity.  In  some  cases  the 
epileptic  fits  come  frequently,  one  or  two  or  three 
(for  they  often  occur  in  "  bouts "  or  sets)  taking 
place  every  few  days.  More  often  they  are 
separated  from  one  another  by  weeks,  sometimes 
by  months,  not  infrequently  by  years.  And  the 
next  fact  is  that  the  occurrence  of  the  fits  is  not 
regular.  If  there  have  been  two  or  three  sets  in 
one  week,  or  in  a  month,  it  does  not  at  aU  follow 
that  there  will  be  a  like  number  in  the  next 
succeeding  week  or  month ;  and  the  same  statement 
is  true  for  longer  periods  of  time,  months,  for 
example,  or  years.  Now  if  the  last  fit  or  set  of  fits 
occurred  six  months  ago,  or  a  year  ago,  and  if  the 
times  of  the  occurrence  of  the  fits  are  not  regular, 
how  are  we  to  know  or  to  judge  what  the  effects  of 
our  treatment  have  been  ?  If  a  longer  interval 
than  formerly  occurs  under  treatment,  it  may  have 
been  because  the  fits  were  not  going  to  return  in 
any  case,  and  the  longer  interval  of  freedom  may 
not,  therefore,  be  due  to  our  treatment,  but  to 
Nature.  No  doubt  it  was  chiefly  for  this  reason 
that  the  ancients  called  epilepsy  the  sacred  disease, 
and  allowed  the  priests,  rather  than  the  physicians, 
to  deal  with  it,  allowing  their  claim  to  be  divine 
agents  if  they  seemed  to  be  successful,  and  if  the 
patient  seemed  to  recover;  and  if  they  failed, 
attributing  the  failure  to  the  belief  that  the  disease 


506 

was  a  sacred  one  and  in  the  hands  of  the  gods  only, 
who  in  this  case  would  not  allow  it  to  be  cured. 
The  same  kind  of  reasoning  led  others  of  the 
ancients  to  think  that  the  disease  was  due  to  the 
patient  being  possessed  by  devils,  and  that  only 
those  could  cure  it  who  had  the  power  to  cast  the 
devils  out.  It  is  certainly  a  little  curious  to  find 
that  the  remedies  of  fasting  and  prayer  were 
greatly  valued  in  managing  epilepsy,  because, 
certainly  so  far  as  I  have  seen,  far  and  away  the 
best  remedy  consists  of  a  careful  restriction  of  the 
diet,  while  the  mental  calm  implied  in  the  act  of 
submission  which  prayer  involves  is  a  great 
adjuvant  to  the  cure.  And  the  mode  in  which 
the  remedy  acts  is  plain  enough.  The  connective- 
tissue  of  the  brain  being  congested  with  lymph, 
restriction  of  the  diet  compels  the  body  to  draw  on 
the  over  -  accumulation  of  its  resources,  and  to 
convert  them  gradually  into  the  heat  and  motion 
of  life,  the  consequences  being  gradual,  or  rather 
intermittent,  relief  to  the  irritation  which  caused 
both  the  dilatation  of  the  pupils  and  also  the 
explosions  of  the  fits.  The  transverse  elements  of 
the  pupils  are,  in  fact,  in  a  state  of  cramp,  as  it 
were,  which  is  slowly  or  intermittently  relieved, 
just  as  cramp  in  the  legs  can  be  relieved  by  cautious 
diminution  of  the  diet.  For  these  reasons,  and 
following  out  this  suggestion  in  treatment,  I  have 
for  many  years  now  advised  restriction  of  the  diet 
in  epilepsy  to  two  meals  daily,  and  sometimes  to 
one ;  and  in  acute  cases  have  recommended  further 


507 

and  great  restriction  to  a  pint  or  a  pint  and  a  half 
of  milk  daily  for  a  considerable  period  of  time, 
some  weeks,  for  example,  and  that  with  excellent 
results,  so  far  at  least  as  results  can  be  guaged  in  a 
condition  which  is  so  irregular  in  its  exacerbations 
and  recessions.  Especially  are  these  results  good 
in  the  case  of  children,  although  older  persons  are 
also  often  very  amenable  to  the  same  line  of 
treatment.  Fasting,  in  fact,  seems  to  be  of  very 
great  efficacy  in  the  treatment  of  epilepsy,  the 
rationale  of  its  action  being  what  I  have  attempted 
to  make  clear  to  the  reader. 

As  has  been  said,  dilatation  of  the  pupils  is 
seen  in  many  other  conditions  besides  epilepsy. 
"  Neurotic,"  or  what  I  have  called  "  initio  "  women, 
full  of  all  sorts  of  ailments,  often  manifest  it,  and 
children  also,  who  sometimes  concomitantly  manifest 
defects  of  vision.  It  sounds  absurd  and  far  fetched, 
until  we  see  its  rationale,  to  say  that  defects  of 
vision  can  be  remedied  by  alterations  of  the  diet  ; 
but  I  have  literally  seen  this  brought  about  in  more 
than  one  case,  having  been  able  to  correct  short- 
sightedness in  children,  for  example,  by  restricting 
the  diet,  and  this  without  the  use  of  glasses,  when 
the  cause  of  the  defect  was  pointed  to  by  Nature 
by  over-dilatation  of  the  pupils  through  over- 
stimulation of  brain  and  nerves,  by  excess  of  food  in 
the  way  detailed.  When,  by  diminishing  the  food, 
irritation  and  over-stimulation  were  reduced,  the 
over-dilatation  of  the  pupils  was  reduced  also, 
and  the  accompanying   defects   of   vision   relieved. 


508 

Over  -  dilatation  of  the  pupils,  one  or  both,  is, 
in  fact,  a  sign  of  such  significance  that  we  can 
often,  by  paying  attention  to  it,  foresee  and  so 
sometimes  prevent  the  onset  of  an  attack  of 
inflammation  of  the  brain  (cerebritis  or  meningitis) 
in  children  or  young  people,  and  by  a  timely 
restriction  of  the  diet  save  and  prevent  damage  to 
young  lives. 

The  considerations  advanced  in  this  essay, 
the  view  that  most  of  our  diseases  are  brought 
upon  ourselves  by  our  own  folly,  by  too  great 
gratification  of  our  appetites,  and  the  consequent 
inference,  so  often  verified  by  proof,  that  most 
of  our  diseases  are  tractable  by  restriction  of  the 
diet,  have  come  to  exercise  a  kind  of  fascination 
on  my  mind.  And  other  considerations  suggest 
themselves  also  to  one's  mind,  conclusions,  for 
example,  as  to  the  uniformity  of  nature,  and  the 
order  and  government  of  the  scheme  of  things 
under  which  we  live,  which,  though  somewhat  out 
of  place  in  an  essay  on  medicine,  are  yet  of  the 
deepest  and  even  most  entrancing  human  interest. 
Nature  has  given  us,  for  example,  with  a  bountiful 
hand,  a  large  variety  of  good  things  to  enjoy.  On 
the  other  hand  she  has  endowed  us  with  the  desire 
to  enjoy  them  ;  but  she  has  left  us  to  discover  by 
observation  and  experiment  what  are  the  effects  of 
free  indulgence  and  of  restraint.  And  it  is  lor  each 
of  us  to  say  what  he  will  do,  how  far  he  will  go,  and 
what  amount  of  government  he  will  attempt  to  put 
upon   himself  during  his  progress  through   life  to 


509 

death — an  infinitely  greater  consideration  than  the 
far  commoner  one,  how  much  influence  he  may  hope 
to  have  over  his  fellows.  But  these  considerations 
and  the  analogous  one  that  thinkers  have  held  that 
all  our  knowledge  is  always  a  mean  between  two 
extremes,  neither  of  which  is  possible,  must  be  left 
aside  by  the  medical  man,  who  yet  is  at  all  points 
compelled  to  conclude  that  neither  ascetic  abstinence 
nor  florid  (nor  yet  anaemic,  nor  tripthaemic)  plethora 
is  healthy  ;  if,  that  is,  as  seems  to  be  the  case,  the 
aim  of  medicine  ought  to  be  to  make  life  fit  for  the 
active  work  whose  performance  itself  brings  happi- 
ness and  helps  to  render  life  free  from  disease. 

On  the  other  hand,  a  certain  amount  of 
depression  is  apt  to  arise  when  one  reflects  that 
comparatively  few  appear  to  see  so  simple  a  way 
out  of  their  troubles,  as  that  to  be  got  through 
control  of  our  appetites,  and  that  of  those  few,  only 
a  small  minority  seem  willing  to  put  their  discovery 
into  practice.  In  every  generation,  however,  a 
minority  of  medical  men  have  apparently  said 
much  the  same  thing  as  the  present  writer.  A 
most  remarkable  instance,  as  we  have  seen,  is 
Hippocrates  in  the  ancient  world.  We  may  also 
instance  Celsus,  who  said,  potius  bis  quam  semel 
in  die  edere,  for  although  he  thought  it  better 
to  eat  twice  a  day  than  once,  he  certainly  did  not 
countenance  the  four  or  five  daily  meals  which,  as 
we  have  seen,  characterised  the  daily  life  of  the 
Boman  citizens  in  the  days  of  the  wealth  and 
luxury   which   preceded   and   caused  their   decline. 


510 

In  the  time  of  the  English  revolution  also,  the 
great  Sydenham  tells  us  how  he  fed  a  gouty  man  on 
milk  and  whey  (serum  lactis)  for  a  year ;  and  just 
before  the  present  time  Dr.  King  Chambers  spoke 
of  the  starvation  of  over-repletion,  to  be  translated 
into  yet  more  idiomatic  and  expressive  language, 
when  Dr.  Dewey  speaks  of  the  starvation  of  over- 
feeding. In  his  day,  Sir  Andrew  Clarke  was  called 
the  starving  doctor  ;  and  it  would  be  invidious  to 
mention  the  names  of  a  few  living  physicians  who 
make  like  deliverances.  How  will  the  view,  the 
view  expounded  and  defended  and  illustrated  (may 
I  say  proved  ?)  in  this  essay — how  will  it  fare  in  the 
future  ?  Will  it  be  accepted  or  rejected  ?  Or  will 
it,  perhaps,  be  accepted  as  a  general  proposition,  or 
as  a  proposition  generally  true,  but  only  to  receive 
practical  rejection  when  the  attempt  is  made  to 
apply  it  to  any  particular  case  ?  It  is  so  easy  to 
see  the  general  law,  but  to  fail  to  see  its  application 
to  our  own  case.  Better,  it  seems  to  me,  would  it 
be  to  denounce  it  out  and  out  than  to  accept  it  in 
a  half-hearted  and  insincere  way.  I  have  often 
thought  what  an  interesting  essay  might  be  written 
on  the  medical  history  of  great  men,  and  how  it 
might  be  shewn  that  their  food  habits  determined 
not  only  their  longevity,  but  many  of  their  moral 
qualities  also.  But  this  task  would  be  too  great 
for  the  termination  of  our  exposition,  although, 
perhaps,  it  would  be  as  interesting  as  any  other 
part  of  it.  I  have  already  mentioned  the  great 
man  who  wrote  the  vision  of  Mirza,  as  a  striking 


611 

instance  of  those  who  say  and  do  not  do. 
But  many  others  probably  do  not  have  the 
opportunity  of  knowing  what  he  knew,  and  so  of 
shewing  whether  they  would  be  willing  or  not  to 
obey  the  law  in  their  own  case.  Illustrations  of  the 
lamentable  efiects  of  ignorance  of  the  law  abound  in 
our  Hterature  to  all  those  who  have  an  eye  to  read 
and  see  them;  and  a  noteworthy  instance  is  afforded 
by  the  medical  history  of  a  well-known  literary 
character  of  the  truth  of  the  statement  that  too 
frequent  and  too  abundant  feeding  cannot  be  borne 
by  average  humanity  without  continually  recurring 
illness  and  premature  death.  Of  course,  if  the  law 
is  the  law,  and  not  a  mere  figment  of  the  imagina- 
tion, it  will  be  found  to  cover  all  cases  belonging  to 
its  own  order,  and  when  exceptions  occur,  some 
peculiarity  in  the  circumstances  must  be  looked  for 
to  account  for  them.  This  Hterary  character  has 
been  depicted  from  her  own  letters  most  fully  for 
our  instruction,  and  it  appears  that  from  somewhat 
early  days  she  suffered  from  recurring  headaches. 
At  a  very  tender  age,  we  are  told,  she  suffered 
greatly  from  cold,  and  found  difficulty  in  getting 
near  the  fire  at  school  in  winter  to  become 
thoroughly  warmed,  owing  to  the  circle  of  girls 
forming  round  too  narrow  a  fireplace.  The 
biographer  is  not  a  physiologist,  but  describes  in 
wonderful  detail,  although  nearly  always  by 
reference  rather  than  description,  the  ailments  from 
which  his  subject  suffered.  The  incident  relating 
to  the  fire  occurred  at  five  or  six  years  of  age.     If 


5ia 

only  the  feeliug  of  cold  had  been  met  by  judicious 
exercises  and  a  wise  regulation  of  the  diet,  in  place 
of  the  futile  attempt  to  get  near  the  fire,  if  the 
oxy-uri-chaemia  causing  the  feeling  had  been  treated 
in  place  of  the  feeling  itself,  how  different  might 
not  the  result  have  been  !  For  the  idea  of  the 
child's  father  was  the  conventional,  and  perhaps 
natural,  one,  till  modified  by  fuller  knowledge,  that 
a  child's  strength  was  to  be  promoted  by  increase  of 
food,  since  we  find  that  at  about  thirteen  years  of 
age,  at  her  next  school,  "^a  source  of  great  interest 
to  the  girls,  and  of  envy  to  those  who  lived  further 
from  home,  was  the  weekly  cart  which  brought 
the  child  new-laid  eggs  and  other  delightful 
produce  of  her  father's  farm" — these  new-laid 
eggs  and  delightful  produce  of  the  farm  being,  no 
doubt,  taken  as  extras  in  addition  to  the  already, 
probably,  quite  sufficient  school  fare.  By  the  time 
the  child  was  nineteen  or  twenty  her  headaches 
were  in  full  swing,  frequent  references  being  made 
to  them.  Thus,  at  twenty  years  of  age,  she  speaks 
of  hardly  knowing  herself,  owing  to  the  insup- 
pressible  rising  of  her  animal  spirits,  "on  a 
deliverance  from  sick  headache."  Evidently  she 
suffered  from  recurring  sick  headaches.  If  only  she 
had  been  told  that  when  persons  suffer  from 
recurring  ailments  they  should  look  for  a  constant 
cause,  or  a  frequently  acting  cause  !  Had  this  been 
done  she  would  have  had  the  option  of  choosing 
whether  she  would  accept  the  unpleasantness  of 
putting  upon  herself  a  certain  amount  of  restraint, 


513 

or  of  going  on  in  the  old  way  and  suffering  from 
the  recurring  ailments.  She  would  have  had  the 
opportunity  and  responsibility  of  choosing  whether 
she  would  belong  to  those  who  know  or  to  those 
who  do  not  want  to  know.  This  heroine  was 
exceptionally  gifted — most  exceptionally  so — and 
saw,  therefore,  though  without  stating  it,  or  perhaps 
without  realising  its  significance,  that  alternation 
which  always  goes  on,  and  always  must  go  on,  in 
the  body  as  to  strictum  and  laxum,  rao-ts  and 
yaX(L(Ti^.  ' '  Have  you  not,"  she  says,  "  alternating 
seasons  of  mental  stagnation  and  activity  ?  "  More 
mental  power  and  less  in  the  waking  state,  that  is 
natural  and  healthy;  but  "stagnation  and  activity" 
have  transcended  the  limits  of  health,  and  are  as 
morbid  or  unhealthy  as  panic  and  boom  in  business 
or  as  depression  and  fever  in  the  body.  The 
ill-health  goes  on,  for  at  twenty-seven  years  of  age 
she  speaks  of  a  cold  and  headache  as  being  doubly 
intolerable ;  and  at  thirty  she  has  headaches  and 
backaches.  At  the  same  age  she  is  suffering  "as 
acutely  as  ever  I  did  in  my  life."  But  a  little 
further  on,  and  at  the  same  age,  when  she  had  gone 
abroad,  we  have  described  to  us,  though  all  uncon- 
sciously, the  chief  predisposing  cause  of  these 
ailments  and  delicate  states,  which  were  thought  to 
be  the  effects  of  hard  work,  of  anxiety,  of  "  exposure 
to  cold,"  of  a  bad,  miserable,  foggy  climate,  etc.,  in 
a  way  which  is  so  instructive  that  it  must  be  quoted. 
"  I  breakfast  in  my  own  room  at  half-past  eight, 
lunch   at    half-past   twelve,   and  dine  at  four  or  a 

GG 


614 

little  after,  and  take  tea  at  eight."  If  one  had 
been  in  search  of  a  plan  to  induce  ill-health  and 
early  death,  one  would  have  adopted  that  of  break- 
fasting, lunching,  dining,  and  having  tea  within 
eleven  and  a  half  hours  of  one  another.  If  anything 
additional  were  wanting  to  destroy  life,  it  would 
have  been  what  some  persons  of  my  acquaintance 
do,  viz.,  to  have  some  milk  and  fruit  brought  up  to 
their  bedrooms,  in  case  they  should  feel  "  faint "  in 
the  night,  or  to  make  a  point,  as  some  of  them  have 
done,  of  rousing  the  maid  in  the  night  to  heat  milk 
or  make  tea  and  bread-and-butter  for  them.  In 
another  place  she  tells  us  that  she  is  becoming  so 
thin  as  to  be  approximating  to  length  without 
breadth  !  Was  that  due  to  under-feeding  ?  Is  it 
likely  that  a  person  taking  four  meals  a  day  would 
sufter  from  direct  starvation  ?  How  is  it  possible  ? 
Was  it  not,  rather,  the  starvation  of  over- 
repletion,  the  attenuation  of  excess  ?  No  doubt  it 
was.  And  the  proper  indication  would  have  been 
to  diminish  or  restrict  the  diet,  not  to  increase  it. 
The  action  of  the  predisdosing  cause  continues.  We 
find  her  describing  herself  as  suffering  from  constant 
colds.  No  sooner  is  one  passing  ofi  by  its  stuffy 
stage  than  another  is  beginning  with  its  wet  one. 
Writing  to  a  friend,  she  unwittingly  informs  us  of 
the  cause  of  this  also.  "  You  know  our  habits,"  she 
says  ;  "  lunch  at  half-past  one,  walk  from  two  to 
four,  and  dinner  at  five."  How  could  any  person 
hope  to  be  well  who  followed  such  pollaki-siteous 
habits  ?       Headache      succeeded     headache,      cold 


515 

succeeded  cold,  backache  and  rheumatism  tormented 
the  patient  ;  and  constant  change  of  air  and  scene, 
with  frequent  runs  to  the  Continent,  were  adopted 
to  get  rid  of  ailments  which  were  not  due  to  climate 
at  all,  but  to  wrong  living.  And  as  the  causes 
continued  their  action,  how  could  the  effects  cease  ? 
But  why  say  more  ?  Alas  !  that  noble  life  came  to 
an  end  at  sixty-one  years  of  age  from  disease  of  the 
kidneys,  intercurrent  attacks  of  headache  and  of 
rheumatism  sadly  interfering  with  work ;  and  the 
world  was  deprived  of  the  maturer  sagacities  which 
would  no  doubt  have  flowed  from  her  pen  as  her  age 
advanced.  Had  she  overcome  the  physical  weak- 
nesses of  humanity,  she  would  have  become  even 
purer  and  more  ennobled,  reflecting  in  advanced  age 
most  clearly  the  transforming  light  as  from  a 
mountain-peak,  ascending  ever  higher  and  nearer  to 
the  heavenly  source  of  knowledge  and  inspiration. 
The  hard  work,  the  anxiety,  the  cold  forbidding 
weather,  the  fog,  and  the  other  drawbacks  of  an 
English  climate  (the  healthiest,  probably,  under 
heaven,  notwithstanding),  would  have  failed  to 
destroy  the  life  so  early,  had  the  foundation  of  it, 
the  nutrition,  been  put  on  a  proper  basis.  And  how 
simple  the  remedy  !  Breakfast  at  half-past  eight 
and  dinner  at  four  or  a  little  after,  with  the  omission 
of  the  lunch  and  the  meal  at  eight  (though  a  cup  of 
tea  alone  might  then  have  been  taken  if  desired), 
such  a  plan  would  have  interfered  with  no  one's 
comfort,  would  have  reduced  labour  to  others  and 
not  increased  it,  would  have  led  to  the  disappearance 

GG  2 


516 

of  the  headaches,  the  backaches,  the  colds  and  the 
rheumatism,  and  would  have  postponed  probably  for 
twenty  years  the  onset  of  the  kidney  disease  which 
so  prematurely  ended  the  life.  Persons  are  so  apt 
to  say  that  they  eat  too  little  at  a  time  to  allow 
them  to  adopt  such  a  plan,  just  as  if  they  could  not 
trust  to  Nature  to  see  that  they  have  enough,  and 
forgetting  or  being  apparently  unwilling  to  see  that 
the  demands  of  the  body  are  much  less  than  their 
preconceptions  declare,  and  that  fine  literary  work 
or  pressure  of  anxious  business  is  certainly  not  to  be 
met  by  poly-siteism  and  pollaki-siteism.  How  many 
literary  lives  of  the  finest  order  and  how  many 
business  lives  of  the  highest  calibre  have  been 
destroyed  in  this  way  twenty,  thirty,  forty  years 
before  their  time,  and  how  many  delicate  and  refined 
mothers  have  left  their  children  motherless  from  the 
same  cause  ! 

I  have  now  mentioned  a  considerable  number 
of  kinds  of  disease  which  afiect  humanity  that  are 
amenable  to  dietetic  treatment,  that  can  be  pre- 
vented by  proper  modes  of  living,  and  particularly 
by  proper  dietetic  modes  of  living,  and  that  can  be 
cured,  if  they  have  not  advanced  too  far,  by  proper 
dietetic  measures.  I  have  shewn  that  these  con- 
siderations are  true  for  bronchitis,  for  broncho- 
pneumonia, for  asthma,  and  for  pneumonia ;  for 
rheumatism  and  gout ;  for  neurosis  and  hysteria,  and 
brain-fag,  neuralgia,  and  even  many  fonns  of  insanity ; 
for  the  fevers  and  the  specific  inflammations,  like 
erysipelas  of  the  face,  and  sycosis  of  the  chin  and 


517 

cheeks  ;  for  senile  and  juvenile  struma  and  scrofula  ; 
for  ulceration  and  for  other  forms  of  disease.  I  have 
shewn  that  the  cause  or  the  main  cause  of  all  these 
various  forms  of  disease  being  improper  feeding, 
they  can  all  be  prevented  and  even  cured  by  having 
recourse  to  proper  feeding.  And  the  curious  and 
simple  consideration  has  been  forced  on  our  attention 
that  the  particular  form  of  improper  feeding,  which 
is  causing  so  many  of  our  diseases,  is  not  too  little 
food,  but  too  much.  So  that  the  cure  in  all  cases, 
or  at  least  in  so  large  a  majority  of  cases  as 
practically  to  amount  to  all  (say  two- thirds  to  nine- 
tenths  of  all  cases  of  illness),  is  not  to  increase  but 
to  restrict  the  diet.  Still  more  curiously  and  more 
simply  does  it  seem  to  arise  from  what  has  been 
said  that  if  we  were  to  feed  our  children  and 
ourselves,  living  in  towns,  on  two  daily  meals,  to 
the  extent  of  say  an  ounce  of  mixed  diet  daily  for 
each  ten  pounds  of  our  body  weight,  or  perhaps  in 
the  case  of  the  children  an  ounce  daily  to  each 
eight  pounds  of  their  body  weight,  we  should 
obtain  on  the  average  very  much  better  health  than 
we  do  now.  Do  we  suffer  from  recurring  attacks 
of  bronchitis,  broncho-pneumonia,  pneumonia,  or 
asthma,  then  let  us  see  what  dissiteism,  to  the 
amount  of  about  a  pound  of  mixed  diet  daily  will 
do  for  us.  Do  our  children  keep  taking  colds,  or 
catching  fevers,  getting  enlarged  tonsils,  or 
adenoids  in  the  nose  ?  Let  us  see  what  we  can  do 
for  them,  after  their  recovery  on  a  fluid  diet,  by 
putting  them  on  two  daily  meals,  consisting  of  say 


518 

an  ounce  of  mixed  diet  daily  for  each  eight  pounds 
of  their  body  weight,  or  on  three  meals  at  the 
outside.  Are  they  suffering  from  juvenile  struma, 
or  are  the  seniors  among  us  suffering  from  senile 
struma  ?  Let  us  put  them  on  two  daily  meals,  and 
the  seniors  even  on  one,  and  they  will  recover  from 
these  serious  evils  more  quickly  and  more  safely 
than  if  treated  by  any  other  means.  Or  do  we  find 
ourselves  suffering  from  specific  inflammations,  like 
erysipelas  of  the  face,  whether  associated  or  not 
with  the  growth  of  micro-organisms  in  the  blood 
and  tissues  of  our  bodies  ?  Let  us  see  what  effect 
two  daily  meals  will  have  on  us  and  our  ailments, 
the  quantity  of  our  food  being  regulated  as 
suggested.  After  50  years  of  age,  let  us  reflect 
that  we  are  safer  with  one  meal  than  with  two,  that 
monositeism  is  better  for  us  than  even  dissiteism, 
but  that  it  is  at  least  much  safer  than  tris-siteism  or 
tetra-siteism,  and  still  more  than  any  larger  number 
of  meals.  Do  we  find  ourselves  suffering  from 
ulceration  anywhere  in  the  body,  between  the  toes, 
for  instance,  or  on  the  face,  or  in  any  part  of  the  skin, 
or  from  eczsema  ?  Let  us  see  what  the  effects  of  the 
same  treatment  will  be,  with  perhaps  some  sooth- 
ing topical  application  to  the  affected  part.  Truly 
the  re-discovery  that  disease  is  one,  one  in  causation 
and  one,  therefore,  in  treatment,  one  also  in  the 
means  to  be  adopted  for  the  prevention  of  its  very 
various  phases  and  forms,  this  re-discovery  is  at  last 
put  to  simple  and  very  practical  and  efiicient  use. 
The  question,  in  fact,  arises  :   are  there  any  diseases 


519 

to  which  these  principles  are  not  applicable  ?  We 
saw,  as  regards  cancer,  not,  indeed,  that  we  may- 
have  much  prospect  of  cure  in  cancer  from, 
dissiteism  or  monositeism,  or  even  a-siteism,  but  that 
under  fasting  and  starvation  its  pain  is  much 
diminished  and  its  suffering  assuaged  ;  while  by  a 
proper  system  of  dieting  there  is  the  strongest 
reason  to  believe  that  this  terrible  scourge  could 
be  prevented  from  attacking  humanity,  and  from 
sweeping  away  its  most  useful  members  in  the  very 
culmination  and  acme  of  their  activity  and  powers. 
Are  there  any  diseases  to  which  the  same  principles 
are  not  applicable  ?  I  do  not  know  of  any. 
The  considerations  advanced  in  former  chapters, 
dealing  with  the  alterations  of  function,  and 
shewing  how  health  and  disease  shade  off  into  one 
another  by  insensible  gradations,  also  shewed  that 
diseases  of  the  heart,  of  the  circulation,  of  the  brain, 
of  the  respiration,  of  the  nerves,  of  the  intestines 
and  of  the  kidneys,  are  all  due  to  changes  in 
nutrition,  and  depend  more  on  digestion,  and  there- 
fore on  food  supply,  than  on  any  other  one  cause, 
and  probably  more  than  on  all  other  causes  put 
together.  What  other  diseases  are  there  which  are 
not  amenable  to  this  consideration  ?  Appendicitis  ? 
The  diagnosis  is  too  pat  in  most  cases.  It  is  not 
the  appendix  which  is  inflamed  in  so  many  of  these 
cases,  so  much  as  the  caecum  or  typhlon,  that  is,  the 
part  of  the  bowel  to  which  the  appendix  is  attached. 
We  have  generally  to  do  with  a  peri-typhilitis,  or  an 
enteritis,  or  inflammation  of  the  bowel,  rather  than 


520 

with  appendicitis.  And  not  infrequently  in  what  is 
called  appendicitis,  the  connective  tissue  of  the 
pelvis  and  of  the  muscles  of  the  abdomen  is  inflamed 
also,  the  suffering  child  wincing  like  the  neurotic 
or  hysterical  woman,  so  called,  when  you  press  him 
even  lightly  on  any  of  these  widely  distributed 
tissues.  Are  we  to  remove  the  typhlon  or  the 
csecum  or  the  gut  itself  to  cure  inflammation  of  the 
bowel  ?  Or  the  connective  tissue  or  muscles  of  the 
abdomen  to  cure  appendicitis  ?  Are  we  to  amputate 
the  head  in  order  to  cure  neuralgia  of  the  face  ? 
Are  we  to  consider  that  the  highest  aim  of 
medicine  and  surgery  is  to  remove  organs  and 
structures  with  which  nature  has  endowed  us  ?  or 
is  it  rather  to  advise  us  how  to  live,  so  that  we  may 
be  able  to  retain  them  in  a  sound  and  healthy 
condition  ?  Truly  the  advances  of  surgery  in  this 
generation  have  been  great.  But  is  there  not  too 
much  surgery  ?  What  if  much  of  it  could  have 
been  made  unnecessary,  and  what  if  much 
impending  surgery  for  the  future  may  be  rendered 
unnecessary  by  proper  methods  of  living  ?  Would 
not  that  be  much  better  than  boasting  of  what  we 
are  able  to  achieve  in  the  way  of  removing  organs 
and  parts  from  these  wonderful  bodies  of  ours  ? 
If  the  duration  of  life  has  been  increased,  how  is  it 
that  the  sickness  is  greater  than  it  was  ?  Is  it  not 
because  in  our  worship  of  wealth  and  luxury  we 
have  forgotten  moderation,  and  are  over-looking 
the  necessity  of  exercising  that  amount  of  self- 
restraint  and  government,  without  which  we  fail  in 


521 

the  noblest  aims  of  humanity  ?  Yes,  it  is  hard  for 
the  children  to  have  to  face  this  question.  I  freely 
admit  it.  Their  elders  do  not  find  it  easy,  but 
sooner  or  later  all  of  us  have  to  face  it.  But  truly 
the  penalty  for  breach  of  the  laws  of  nature  is  not 
averted  by  any  frantic  appeal  of  ours,  from  the 
tender  young  or  feeble  old ;  nor  can  it  even  be  made 
to  fall,  much  though  we  might  desire  it,  only  on  the 
mature  and  on  those  who  are  or  ought  to  be  most 
able  to  bear  it.  Therefore,  it  seems  to  me,  even 
the  children  must  be  taught,  and  that  early,  what 
is  the  nature  of  the  law  and  of  the  government 
(merciful  and  gracious  as  it  seems  to  me)  under 
which  we  live.  And  if  instruction  is  thus  early 
imparted,  the  feeble  old  will  not  be  called  upon 
to  bear  anything  more  than  their  strength  will 
allow. 

Now  I  daresay  it  will  be  easy  to  bring  ridicule 
to  bear  on  what  has  been  said.  It  will  be  repre- 
sented that  monositeism  and  dissiteism  are  held  up 
as  a  panacea  for  all  the  ills  of  humanity.  I  know 
as  well  as  any  omniscient  critic  that  there  is  no 
panacea  against  suffering.  Do  what  we  will  or 
may,  there  will  always  be  a  great  deal  of  it.  That 
also  has  its  lessons,  with  which  I  do  not  pretend  to 
deal.  But  if  any  man  can  tell  us  what  better 
remedy  (even  if  there  is  no  panacea)  there  is  for 
the  evils  of  life  than  moderation  in  all  things, 
whether  in  work  or  rest,  in  food  or  drink,  in  joy 
or  sorrow,  in  egoism  or  altruism,  he  will  do 
well  to  declare  it.     And  if  he  can  offer  a  better 


522 


approximation  than  mine  towards  the  definition  of 
what  moderation  is,  no  one  will  be  readier  than  I  to 
consider  and  adopt  it. 


523 


CHAPTEE    XIII. 


The  Effect  of  Exercises  on  the  Body. 


T  HAVE  said  very  little  hitherto,  beyond  the 
reference  made  in  discussing  Mr.  Smith's  letter 
in  the  last  chapter,  on  the  effects  of  exercises  on  the 
human  body.  By  implication,  indeed,  I  have  said  a 
good  deal,  or  at  least  the  reader  has  been  left  to 
infer  a  good  deal.  Dr.  Dewey,  with  the  fine 
medical  insight  that  characterises  him,  thinks  that 
exercises  are  not  particularly  indicated  for  the 
preservation  of  health,  in  this  agreeing  with  some 
ancient  authorities,  notably  Erasistratus,  who  said 
much  the  same  thing.  I  have  already  mentioned 
my  own  agreement  with  both  of  these  authorities, 
provided  that  people  in  general  took  no  more  food 
than  they  require  in  order  to  keep  the  body  in 
health  and  efficiency.  But  as  most,  and  in  fact 
nearly  all  of  us  do  fall  into  the  latter  mistake,  I 
still  agree  with  the  majority  of  the  ancient  and 
modern  physicians  in  recommending  moderate 
exercises  to  be  taken,  especially  in  the  act  of 
dressing  in  the  morning,  in  order  to  keep  the  body 
supple,  young  and  active,  and  in  order  to  render 
ourselves  more  efficient  for  the  work  of  the  day. 
But  I  think  I  ought  to  enter  a  caveat  about  their 


524 

use.  For  if  a  man  persistently  over-fills  his  blood 
and  connective  tissues  with  material  ingested 
greatly  in  excess  of  his  requirements,  he  will  find 
himself  sufiering  particularly  in  two  disadvantageous 
ways.  In  the  first  place,  he  will  find  himself  very 
much  disinclined  for  exercises,  and  secondly,  when 
he  takes  them,  they  will  seem  to  tire  him  instead  of 
freshening  him.  He  may  even  do  himself  harm  by 
them,  especially  if  they  are  violent  or  severe,  or  too 
long  continued  or  too  suddenly  entered  upon.  I  do 
not,  for  example,  think  it  is  at  all  a  wise  thing  for  a 
man  engaged  for  weeks  or  months  in  somewhat 
sedentary  business  pursuits,  to  go  out  for  a  long 
day's  shooting,  involving  heavy  exercise  or  laborious 
tramping  over  rough  ground.  If  he  has  been 
over-working  his  digestion  for  a  long  time,  and  if  he 
then  adds  to  his  overwrought  organism  the  labour 
of  action  and  sustained  exercises,  to  which  he  has 
been  for  long  unaccustomed,  he  will  simply  damage 
himself,  because  he  will  be  over-working  his  body  in 
two  directions.  He  might  possibly  be  able  to 
sustain  the  labour  of  one  of  these  (though  of 
course  even  that  would  not  be  wise),  but  the 
combination  of  the  two  will  be  almost  certainly 
harmful.  The  efiects  are  a  little  like  those  of  both 
eating  and  drinking  too  much.  It  is  most  unwise 
to  do  either,  but  to  do  both  together  is  certainly 
more  damaging  than  to  do  one  alone.  And  so  with 
exercises  and  over-feeding  or  over-drinking.  The 
business  man,  therefore,  who  wants  to  go  shooting, 
had  better  take  say  a  couple  of   hours'  exercise  of 


526 

that  sort  the  first  day,  and  go  for  a  forenoon  or  an 
afternoon  on  the  two  or  three  next  succeeding  days, 
before  he  ventures  on  spending  the  whole  day  in 
work  to  which  for  a  long  time  he  has  been  un- 
accustomed. And  the  same  general  rule  ought  to 
govern  the  taking  of  any  kind  of  exercise,  as  riding, 
bicycling,  cricketing,  football,  &c.,  it  ought  to  be 
entered  on  gently,  and  gradually  increased.  There 
can  be  no  doubt  at  all  that  much  damage  has  often 
been  done  by  neglect  of  this  rule.  Of  course,  for 
the  countryman,  accustomed  to  ride  or  to  do  heavy 
manual  labour,  the  same  precautions  would  not  be 
necessary.  But  I  am  advising  townsmen  for  the 
most  part ;  or  coimtry  people,  who,  although  they 
may  live  in  the  country,  are  yet  occupied  in  what 
may  be  considered  as  townsmen's  work ;  and  it  is 
these  whom  I  have  in  my  mind,  as  indeed  they  form 
the  large  majority  of  the  people  of  England  (and 
most  other  civilised  lands)  to-day. 

The  subject  of  exercise  has  hardly,  I  think, 
received  adequate  consideration.  True,  the  public 
school  education  of  England  has  always  laid  great 
stress  on  the  value  of  games  and  exercises,  the 
influences  of  which  have  been  most  beneficial  on 
the  health  of  her  boys  and  young  meiL  But  until 
comparatively  recent  times  this  means  of  develop- 
ment has  been  almost  wholly  neglected  in  the  case 
of  girls.  With  them,  as  with  grown  up  women, 
it  used  to  be  assumed  that  the  performance  of 
the  business  of  life  would  provide  sufficient 
exercise  for  the  various  muscles  of  the  body.     At 


526 

least,  nothing  was  so  common,  when  exercises 
were  recommended  for  young  or  old,  as  for  the 
medical  man  to  be  told,  "  Oh,  I  am  moving  about 
from  morning  till  night.  I  cannot  require  exercise. 
If  an3i:hing,  I  have  too  much. "  But  the  muscular 
movements  involved  in  the  performance  of  the 
business  of  life  are  very  often  monotonous,  and 
involve  the  performance  over  and  over  again  of  the 
same,  and  that  a  limited  number  of  movements  or 
of  exercises.  Take,  for  instance,  the  life  of  the 
woman  doing  domestic  work.  Her  occupation  is 
varied  enough,  certainly.  To  be  one's  own  cook 
and  housemaid,  and  charwoman,  and  nurse,  and 
laundress,  all  at  once,  at  short  and  alternating 
intervals,  seems  to  imply  the  need  of  making  a 
large  variety  of  movements.  And  yet,  even  with 
all  these,  certain  muscles  hardly  get  exercised  at 
all.  How  stiff  many  of  the  women,  so  occupied 
all  day  long  and  day  after  day,  become  in  the 
muscles  of  the  back,  for  instance,  is  well-known  to 
those  who  have  to  advise  them.  Of  course  some  of 
these  conditions,  as  well  as  the  peliosis  from  which 
so  many  women  suffer,  are  due,  as  has  been  said  so 
often,  to  the  wrong  food  habits  in  which  so  many 
of  them  indulge.  Still  some  of  the  effects  are 
attributable  to  confinement  indoors,  and  to  the 
absence  of  methodised  exercises.  In  fact,  such 
women  suffer  from  three  great  hurtful  conditions — 
too  frequent  eating,  absence  of  fresh  air,  and  want 
of  methodised  exercises.  We  have  seen  how  the 
first  cause  over-fills  the  connective  tissues  of  the 


527 

body  with  lymph  and  lymph-corpuscles ;  and  it 
is  easy,  therefore,  to  see  how,  before  this  has 
culminated  in  its  effects  by  acting  over  a  very  long 
time,  these  effects  can  be  combated  at  least  to 
some  extent  by  well  devised  exercises,  since  these 
stimulate  the  circulation  and  lead  to  the  oxidation 
and  combustion  of  some  of  the  unused  stuff* 
accumulated  in  the  body.  It  is  an  interesting 
thing,  also,  that  the  performance  of  methodised 
movements  for  ten,  fifteen,  or  twenty  minutes, 
twice  a  day,  not  only  does  not  add  to  the  fatigue 
of  persons  so  occupied,  but  positively  diminishes  it. 
and  enables  them  to  do  their  daily  work  better.  It 
is  better  to  rest  a  little  after  these  movements  ;  but 
if,  for  instance,  they  have  been  taken  in  the 
morning,  finishing  the  act  of  dressing  usually  gives 
aU  the  rest  required,  and,  after  a  drink  of  hot 
coffee  or  tea,  one  is  stimulated  for  the  vigorous 
entrance  on  the  work  of  the  day,  which  will  be 
done  effectively,  as,  like  a  spring  compressed  and 
gradually  uncoiling,  the  body  gradually  gives  out 
the  energy  received  by  sleep  and  from  the  food  of 
the  day  before,  in  the  form  of  heat  and  work  done. 
Few  persons  are  so  occupied  that  they  cannot  spare 
the  time  required  for  such  exercises.  What  sort  of 
exercises  ?  The  ancients  appear  to  have  used  two 
main  sorts,  what  they  called  gestatioj  and  what  was 
called  exercitatio ;  or  what  we  should  now  term 
passive  and  active  movements.  On  the  whole,  a 
good  deal  of  importance  seems  to  have  been 
attached  to  exercises  by  the  Roman  physicians.     I 


528 

do  not  suppose  for  a  moment  that  their  advice 
would  be  followed  by  the  mass  of  the  people.  The 
social  condition  of  the  population  would  act  as  an 
effectual  barrier  to  that,  as  unfortunately  it  still 
does  to  a  great  extent  to  the  mass  of  the  people  of 
our  own  day.  But  we  find  Celsus  writing  after  this 
fashion.  '*  He  whom  either  domestic  or  civil  duties 
have  occupied  during  the  day  ought  to  set  apart 
some  time  for  the  care  of  his  body  (curationi  cer ports 
suij,  and  his  first  care  is  exercise  (exercitatio) , 
which  ought  always  to  precede  food.  And  exercise 
ought  to  be  more  elaborate  (amplior)  in  the  case  of 
him  who  has  worked  little  and  has  been  well 
supplied  with  food "  (bene  concoxit — it  is  really 
surprising  how  much  these  ancient  physicians  knew) 
"  while  it  should  be  less  in  the  case  of  those 
fatigued  with  labour,  and  who  may  have  digested 
less." 

As  to  passive  movements,  "  the  most  gentle 
gestation,"  says  Celsus,  "is  that  of  a  ship,  either  in 
a  harbour  or  a  river  ;  the  more  violent  is  on  the 
high  sea  or  in  a  suspension  couch  {lecticd)  ;  more 
violent  still  is  that  of  a  carriage.  And  indeed  each 
of  these  may  be  either  intensified  or  rendered  more 
gentle.  If  there  be  none  of  these  things  within  a 
man's  reach,  a  bed  ought  to  be  suspended  and 
moved  from  side  to  side.  If  there  be  not  even 
that,  a  prop  is  to  be  put  under  one  foot,  and  by  this 
fulcrum  the  head  is  to  be  propelled  backwards  and 
forwards  by  the  hand." 

A    rather    strange,    but    certainly   interesting 


529 

picture,  this,  of  the  passive  movements  which  were 
prescribed  for  patients  in  the  second  century  of  the 
Christian  era  !  It  is  to  be  hoped  that  they  were 
beneficial.  The  active  exercises  were,  on  the  other 
hand,  "  reading  aloud  {clara  lectio),  the  use  of  arms, 
the  ball.  Running  and  walking  are,"  he  says, 
"  very  convenient  exercises ;  the  latter  of  which 
would  be  more  advantageous  if  not  on  a  plane, 
since  the  body  may  be  exercised  better  by  an 
ascending  and  descending  variety,  unless  it  be  very 
weak.  And  it  is  better  in  the  open  air  than  in  a 
portico ;  better  in  a  shade  formed  by  walls  and 
shrubberies  than  that  which  is  under  a  roof ;  a 
straight  walk  is  better  than  a  winding.  But 
incipient  perspiration  ought  generally  to  terminate 
the  exercise,  or  at  least  lassitude  short  of  fatigue, 
and  even  in  this,  itself,  it  ought  to  be  sometimes 
more,  sometimes  less.  And,  indeed,  there  ought  to 
be  no  fixed  rule  {nee  certa  esse  lex)  nor  immoderate 
labour  in  these  exercises,  in  imitation  of  the 
athletes.  Unction  very  properly  follows  these 
exercises  sometimes,  either  in  the  sun  or  before  the 
fire  ;    at    another   time  a  bath,   but  in  a  chamber 

as   high,   light,   and  spacious  as   possible 

After  these  things  it  is  necessary  to  rest  a 
little." 

The  elaboration  of  the  bath  also  is  well  known 
to  have  reached  some  perfection  amiong  the  Romans, 
with  its  tepidarium,  calidarium,  and  laconicum,  its 
solium,  piscina,  and  frigidarium  ;  besides  the 
adjuncts  of  the  aquarium  or  reservoir,  vasarium,  or 

HH 


530 

place  for  holding  the  vessels  where  the  water 
was  heated  ;  and  the  hypocaustum  or  stove. 

If  we  set  aside  the  somewhat  fanciful  arrange- 
ments and  advice  as  to  passive  movements 
{gestatio),  I  think  we  must  admit  that  the  ancient 
physician  who  recommended  the  arrangement  for 
active  movements  [exercitaiio)  knew  well  in  this 
matter,  as  in  so  many  others  that  he  wrote 
about,  what  he  was  talking  of,  and  gave  good 
advice.  He  may  not  have  known  anything  about 
oxidation,  or  about  the  accumulation  of  various 
waste  products  in  the  connective  tissues  of  the 
body.  Still  less  could  he  have  named  those 
products  ;  but  his  juxta-position  of  digestion  (con- 
coquere),  with  movements  [gestatio  and  exercitatio), 
and  his  clear  perception  of  their  interdependence 
and  relations  to  one  another,  mark  him  out  as 
possessing  the  insight  required  by  the  accomplished 
physician  of  all  times.  It  is  the  same  man  who 
formerly  compelled  our  admiration  when  dealing 
with  the  pulse  and  with  the  allowances  which  ought 
to  be  made  for  changes  occurring  in  its  rate  and 
rhythm,  and  that,  many  hundreds  of  years  before 
the  discovery  of  the  circulation  of  the  blood. 

As  to  the  exercises  themselves,  the  reader  may 
ask,  of  what  sort  they  should  be.  They  should  be 
arranged  so  as  to  move  in  a  methodic  manner  all 
the  muscles,  not,  as  is  too  often  the  case,  to  move 
some  muscles  to  the  exclusion  of  the  rest.  Games 
are,  of  course,  most  useful  for  this  purpose.  The 
games  ought  to  be  such  as  are  not  too  violent.     For 


531 

young  people,  of  course,  more  freedom  and  rapidity 
of  movement,  and  more  exertion  are  allowable  than 
for  middle-aged  or  elderly  persons.  Cricket,  which 
involves  both  the  action  of  running,  and  the  many 
movements  of  throwing,  catching,  striking,  and 
finding  the  ball,  is,  of  course,  an  admirably 
contrived  set  of  exercises.  Football  also  might 
perhaps  be  so,  if  it  could  be  relieved  of  its  present 
drawbacks.  A  game  which  involves  wrestling  and 
struggling  so  fierce  as  to  wrench,  and  strain,  and 
sprain  muscles  and  ligaments,  fracture  collar  bones, 
shoulder  blades,  ribs  and  legs,  and  do  other  grievous 
bodily  injury,  may  be  a  good  game  and  a  well 
devised  exercise  in  itself,  but  it  is  in  need  of  reform. 
Lawn  tennis  also  is  a  very  good  game,  its  few 
drawbacks  being  comparatively  easily  overcome. 
Golf  seems  to  be  in  all  ways  a  most  admirable 
game ;  and  no  doubt  there  are  others,  as  billiards, 
&c.,  which  are  suitable.  Walking  the  deck  on 
shipboard  has  a  fascination  for  many  people, 
providing  exercise  in  the  open  air  with  the  least 
possible  fatigue,  and  having  the  advantage  that  it 
can  be  stopped  at  any  moment  that  fatigue  is  felt, 
and  can  be  as  readily  resumed.  Walking,  running, 
leaping,  fencing,  boxing,  the  use  of  the  rings  and 
parallel  bars,  and  the  various  movements  involved 
in  the  use  of  arms,  are  all  useful,  and  of  much 
benefit  to  those  who  can  indulge  in  them.  Mention 
should  also  be  made  of  the  bicycle  and  tricycle 
now  so  much  in  vogue.  No  doubt,  most  valu- 
able   exercises   can   be   obtained   by   their    means, 

HH  2 


532 

particularly  by  women,  whose  lymph  and  blood 
circulation  can  often  be  stirred  up  in  such  a  way  as 
to  materially  improve  many  of  those  chronic  initic 
invalids,  whose  cases  are  at  once  the  despair  of  the 
medical  profession,  and  the  cause  of  so  much  distress 
and  despondency  to  patients'  friends.  No  doubt  it 
is  in  wrong  food  habits,  and  in  the  absence  of  exercises 
that  the  causes  of  these  depressing  ailments  are  to 
be  found ;  and  the  bicycle  offers  a  means  of 
supplying  a  useful  form  of  the  one  necessity,  while 
by  stimulating  the  digestive  powers  to  greater 
activity,  it  will  also  help  to  supply  the  other  aid  to 
healthy  life.  Of  course  all  good  things  must  be 
used  in  moderation.  Already  there  are  whispers  of 
the  overuse  of  this  form  of  exercise  (as  from  time 
to  time  there  are  also  of  others).  It  is  devoutly  to 
be  hoped  that  abuse  of  a  form  of  exercise,  very 
good  in  itself,  may  not  justify,  or  seem  to  justify, 
a  denunciation,  which,  even  if  merited  by  cases  of 
abuse,  will  be  likely  to  restrict  its  proper  use. 
There  is  everything  to  recommend  the  prescription 
of  the  use  of  bicycle  exercises  (and  this  applies  also 
to  all  exercises),  for  such  lengths  of  time  as  patients 
can  bear,  whether  for  half  an  hour,  or  an  hour,  or 
two  hours,  according  to  the  needs  of  the  particular 
case.  The  marks  of  a  well  balanced  mind  are  that 
we  should  use  things  which  are  helful  to  life  in  a 
more  or  less  equal  and  equable  manner,  with 
variations  of  less  and  more,  indeed,  according  to  the 
varying  circumstances  of  the  moment,  and  accord- 
ing to  the  varying  needs  of  life.     But,  on  the  other 


633 

hand,  we  should  avoid  those  extremes  of  rush  and 
torpor,  of  too  excited  use  alternating  with  unmerited 
neglect,  of  too  enthusiastic  recommendation  and 
too  vehement  denunciation,  which  are  the  character- 
istics of  want  of  balance  in  the  mind  of  the 
individual,  of  the  community,  or  of  the  medical 
profession. 

All  these  modes  of  exercise,  however,  require 
much  time^  and  many  of  them  involve  more  expense 
than  can  be  afiorded  by  the  average  man  and 
woman.  Happily  the  board  schools  now  train  both 
boys  and  girls  in  movements  and  exercises  admirably 
adapted  to  health.  In  later  life,  most  men  and 
women  soon  find  that  the  main  object  of  life  is  not 
amusement,  but  work  ;  and  it  too  often  seems  more 
or  less  of  a  satire  to  advise  those  who  are  ill  to 
resort  to  out-door  exercises.  However  admirable 
the  advice  is  in  itself,  it  is  too  often  impossible  to 
follow  it ;  and  indeed,  had  it  been  possible  to  adopt 
and  adhere  to  it,  the  patients  might  in  many  cases 
have  escaped  being  ill  at  all.  But  there  are  few 
persons  so  poor,  or  so  much  occupied,  as  to  be 
unable  to  afford  to  give  five,  ten,  fifteen,  or  twenty 
or  thirty  minutes  to  methodised  movements  twice  a 
day,  movements  devised  for  the  exercise  of  all  the 
muscles  of  the  upper  limbs,  of  the  head  and  neck, 
of  the  ribs  and  trunk,  of  the  abdomen,  of  the 
flanks,  of  the  thighs  and  legs.  And  everyone  who 
wishes  can  suspend  a  pair  of  rings  from  a  beam  in 
the  roof,  or  can  use  light  dumb  bells  (they  need  not 
weigh  more  than  two  pounds  each),   or  clubs,    even 


534 

if  he  cannot  find  time  or  means  to  visit  a 
gymnasium  regularly,  Of  course  the  society  found 
at  a  gymnasium  adds  a  healthful  stimulus  to  life, 
and  may  be  recommended  to  all  who  can  make  the 
opportunity  to  visit  one.  For  those  whose  time  is 
limited,  or  who  for  other  reasons  cannot  use 
gymnastic  instruction,  nothing  could  be  better  than 
to  read  the  little  book,  say,  of  Dr.  Schreber 
(Leipzig,  Fleischer — it  has  lately  been  translated  by 
Day,  of  Norwich)  entitled  "Aerztliche  Zimmer- 
gymnastik."  This  little  gymnastic  instructor, 
"made  in  Germany, "  in  its  25th  edition,  when  I 
last  saw  it  (the  last  edition  consisting  of  10,000 
copies),  gives  wood-cuts  of  a  large  number  of 
muscular  movements  and  bodily  positions,  most 
admirably  devised,  and  as  pictorially  instructive  to 
those  who  cannot  read  German  as  to  those  who  can. 
It  says  much  for  the  sound  sense  of  our  German 
friends  that  there  should  be  among  them  so  great  a 
demand  for  so  useful  a  book,  and  offers  an  example 
which  all  would  do  well  to  follow,  both  in  this 
country  and  elsewhere.  I  might  also  mention  the 
chart  published  by  Professor  Dowd,  of  New  York, 
as  offering  an  excellent  pictorial  exhibition  of  useful 
movements. 

There  are  also  other  valuable  guides  to 
methodised  exercises.  Especially  does  attention 
seem  to  have  been  bestowed  on  these  in  the  United 
States  of  America.  The  foundation  of  such 
literature  in  modern  times  is,  of  course,  the  Swedish 
system  inaugurated  by  Ling.     But  as  a  development 


535 

•on  this  we  have  the  handbook  of  school  gymnastics, 
by  Baron  Nils  Posse  (Lee  and  Shepard,  Boston),  a 
small  but  well  arranged  set  of  progressive  exercises 
for  children.  Then  there  is  the  physical  culture  of 
Louise  Preece  (C.  W.  Bardeen,  Syracuse,  N.Y.), 
which  deals  not  only  with  systematic  exercises  and 
movements,  but  also  to  a  considerable  extent  with 
the  expression  of  the  emotions  by  gesture.  And  a 
Httle  book  by  Edwin  Checkley,  entitled  "  A  Natural 
Method  of  Physical  Training"  (London  :  24, 
Bedford  Street ;  Strand  ;  and  New  York  :  27,  West 
Twenty- third  Street  ;  G.  F.  Putnam's  Sons),  ought 
to  be  mentioned.  Then  there  are  ' '  Sound  Bodies 
for  our  Boys  and  Girls,"  by  William  Blaikie 
(London  :  Sampson  Low,  Marston  and  Co.),  and 
"  Modern  Gymnastic  Exercises,"  by  A.  Alexander, 
F.B.G.S.,  both  of  them  very  good  books.  All  of 
these  works  give  valuable  information  regarding 
exercises,  and  the  methods  of  performing  them,  and 
may  be  consulted  with  advantage.  And  no  doubt 
there  are  others,  as  Sandow's  and  Whiteley's 
Exercisers,  which  are  also  useful. 

With  these  representations  before  one,  it  is 
possible  to  avoid  the  verbal  descriptions  which 
would  take  up  so  much  space,  and  which  would  not 
then  be  so  clear  as  the  wood-cuts  themselves.  And 
I  can  go  on,  therefore,  to  say,  respecting  muscular 
movements,  that  the  best  time  to  take  them  is 
before  a  meal,  as  Celsus  says,  or  immediately  after, 
before  digestion  has  fairly  begun  ;  otherwise  it  is 
not    wise    to    take  them  say    a    couple    of  hours 


536 

after  food,  as  then  digestion  is  in  full  swing,  and 
the  economy  ought  not,  so  to  say,  to  have  its 
attention  disturbed  when  engaged  in  the  digestive 
process.  Four  or  five  hours  after  a  meal,  on  the 
other  hand,  or  an  hour  or  so  before  the  next  one, 
is  a  suitable  time,  as  the  movements,  especially  if 
aided  by  the  drinking  of  half  a  pint  of  water, 
stimulate  vitality,  increase  oxidation,  improve  the 
power  and  rapidity  of  the  circulation  for  the  time, 
and  stimulate  the  digestive  viscera  to  complete  the 
digestion  of  the  previous  meal.  Another  thing 
which  these  movements  effect  is,  by  stimulating  the 
power  and  rapidity  of  the  capillary  circulation,  to 
prevent  the  deposition  in  the  connective  tissue  of 
those  waste  products  which  are  apt  to  be  filtered 
out  of  the  blood  at  that  period  of  digestion,  and 
even  to  remove  them  if  such  deposition  has  already 
occurred.  In  this  way,  neuralgias,  "  brain-fag," 
rheumatisms,  &c.,  tend  to  be  prevented,  and  even 
cured.  The  best  time  for  the  taking  of  exercises 
seems,  therefore,  to  be  in  the  morning,  in  the  act  of 
dressing.  The  proper  use  of  them  may  involve  the 
getting  up  in  the  morning  twenty  or  thirty  minutes 
sooner  than  usual,  not  a  bad  suggestion  for  any  of 
us.  I  think  movements  may  with  advantage  be 
had  recourse  to  once  again  in  the  course  of  the  day, 
at  some  convenient  time,  as  the  organism  does  not 
seem  to  retain  the  impress  of  actions  of  this  sort 
for  more  than  twelve  hours.  Of  course  once  a  day 
is  better  than  not  at  all ;  but  to  parody  the  words 
of  Celsus  about  food,   it    seems   to  me   that   it    is 


537 

better  to  have  exercises  twice  than  once  a  day, 
potius  his  die  quam  semel  exercitationem  capere. 
If  this  be  admitted,  the  best  time  for  the  second 
set  of  exercises  will  be  about  four,  or  five,  or  six 
o'clock,  according  as  people  have  more  leisure  time. 
The  well-to-do  have  often  a  toilet  to  perform  at  that 
time,  and  a  cup  of  afternoon  tea  taken  then  will 
stimulate  and  aid  the  ejffect  of  the  exercises.  The 
workpeople  return  from  work  about  the  later  hour, 
and  have  their  evening  meal  afterwards.  If  the  bath 
has  been  taken  in  the  morning,  there  is  no  need  for 
another  then  ;  but  if  not,  and  if  there  is  leisure  for 
for  it,  the  addition  of  a  bath  to  the  afternoon 
exercises  will  add  to  their  refreshing  influences,  and 
to  the  feeling  of  ease,  lightness,  and  freshness 
which  they  induce. 


Index  of  Words,  Proper  Names,  Subjects,  and 
Etymology  of  Words  not  explained  in  the 
text. 


PBSTINENCE.     And   alcohol,    123  ;    well  borne   by   old 
persons,   379  ;   ill-borne   by   children,    379,    455,   465 ; 
and  plethora,  509. 
Accident.     And  principle,    238 ;      and   essence,    480 ;      as   a 

cause  of  death,  49-50. 
Acid.     Uric,  309  ;  carbonic,  4  ;  gastric,  146. 
Acne,  78. 
Action.     Defective,    excessive,    irregular,    215    et    seq.      See 

Dilatation  and  Contraction  ;  also  Function. 
Activity.     And  stagnation,  513. 
Acute.     Of  disease,  91  et  seq. 
Addison,  283,  510. 
Adenoids,  129. 
Aeginetus  (Paulus),  356. 
Aetiology  or  Etiology.    Causation,  439.    From  ama  =  cause, 

and  Xoyo5  =  description. 
Africa  (South),  104-5. 
Age.     Periods,  33  ;  old,  58. 
Ague.     And  diet,  453. 
Aim.     Of  Medicine,  396. 

Air.     Bad,  and  fever,  111  ei  seq. ;   deprivation  of,  230. 
Alexander,  535. 
Alcohol.     Alcoholism,  74-81,  311 ;  and  abstinence,  123  ;  and 

food,  312,  440  ;  a  relaxant,  211. 


540 

Alderehot,  293. 

Alimentary.     Disease,  54. 

Aliemaiio  vel  Complexio,  210. 

Amylism.  See  Poly-amylism.  From  d  privative  =  and  fxyXri 
=  mill.  Meaning  is,  that  portion  of  cereal  grain  not 
ground  in  the  mill ;  starch. 

Anaemia.  From  d  privative  and  alfxa  =  blood  =  bloodless- 
ness.     Case  of,  204-5,  256,  471  et  seq  ;  pernicious,  498. 

Ancient  views.  Of  heredity,  342  et  seq  ;  on  feeding  infants, 
356  ;  physicians,  what  they  knew,  140-2. 

Animal,  animals,  animal  spirits,  161 ;  physical  and  meta- 
physical, 162  et  seq  ;  slaughter  of,  323 ;  domestic  and 
cancer,  412. 

Anxiety.  And  Job,  336 ;  and  children,  352  et  seq  ;  and  sex 
and  cancer,  425  et  seq  ;  and  influenza,  337. 

Apoplexy.  From  aTTO  =  from,  and  ttXtJ^lo-  =  stroke  or 
blow  ;  classification  of,  72. 

Appendix,  appendicitis,  22,  519. 

kpicnov,    AvdpLO'TO^.     Breakfast,  breakfastless  ;  no  break- 
fast plan  not  new,  267. 

Arteries.  From  aprrjpiaL ;  connected  with  aiqp  =  air  ;  term 
applied  to  arteries  going  from  the  heart,  because  after 
death  they  were  always  found  empty,  and  supposed 
therefore  in  life  to  be  full  of  air,  127 ;  pulmonary,  150  ; 
of  brain,  160  ;  definition  of,  163 ;  coats  of,  187. 

Arthritis.     From  "XpBpov  =  socket  of  joint,  451. 

Asclepiades  of  Prusa,  92,  99,  492. 

Asthma.  From  '^AcrOfxa  =  panting  breath,  or  breath  simply  ; 
means  difficult  breathing  ;  cause  and  cure,  445  et  seq. 

Astronomy,  7. 

Asylums,  246-7. 

Atavism.     See  Heredity. 

Athenaeus,  116,  118. 

Atwater,  279  et  seq. 


541 

B. 

Baby,  beggar's,  239  ;  rich  woman's,  240  ;  feeding  of,  288. 

Bacillus.  Tuberculosis,  and  excess  of  lymph,  171 ;  probably 
in  most  persons,  171  ;  of  diphtheria,  384  ;  and  causation, 
433,  482. 

Bacon,  15. 

Balanced  mind,  well,  532. 

Banks,  Sir  W.  M.,  428. 

Banquets,  numerous.     Effects  of,  117  et  seq. 

Basic  slag.     And  clover,  172-3. 

Baths.  Among  Eomans,  529 ;  component  parts  of  Boman 
baths,  529-30. 

Beaumont,  Dr.,  297  et  seq.     Beef,  and  hot  water,  447-8. 

Beggar's  baby,  239,  361.     Bicycle,  531. 

Birth-rates,  39-48.    Blaikie,  535.     Bleeding,  blood-letting,  139. 

Blood.  Circulation  of,  139  et  seq ;  distribution  of,  155-62 ; 
Made  from  food,  151 ;  nourishes  body,  151  ;  goes  every- 
where in  body,  152  ;  blood  in  brain  not  under  government 
of  heart,  159 ;  corpuscles,  163  et  seq,  191 ;  and  fasting, 
290-2 ;  dumping  ground  of  314  ;  foreign  matter  in,  400 
ei  seq. 

Boa-constrictor,  147.     Body,  living  on  itself,  203. 

Boer  war,  food  of  soldiers  in,  115.     Boxing,  531. 

Boom,  and  panic,  217  et  seq,  513.     Bracing,  87. 

Brain.  Paralysis,  67 ;  fag,  503,  536 ;  blood  in  and  in  spinal 
cord,  158 ;  circulation,  government  of,  159  ;  action  of, 
hindered  by  too  much  blood,  160. 

Braithwaifce,  Dr.,  428-30. 

Bread.  Given  in  excess,  200 ;  illnesses,  caused  by,  200 ;  in 
infirmaries,  284. 

Breakfast.     No  breakfast  plan  not  new,  267. 

Brief,  of  disease,  97  et  seq.  British  Army,  and  consumption, 
330-1. 

Bronchi,  bronchia,  bronchitis,  53,  72, 127 ;  name,  228  ;  caused 
and  cured  by  diet,  444-60  ;  dogma  on,  454. 


542 

Broncho-pneumonia,  105  ;  and  diet,  453. 

Bruising,  321-3;  see  peliosis.     Bumey  Yeo,  Dr,,  66. 

Business,  course  of,  and  medicine,  216-9. 

C. 

Caecum,  or  blind  gut,  so  called  by  Latin  name ;  Greek, 
TV(f)\ov,  because  it  ends  in  a  cul  de  sac,  23,  228. 

Caelius  Aurelianus,  128. 

Calories,  197  ;  and  milk,  248,  277  et  seq  ;  304  et  seq. 

Cancer.  Mortality  from,  59-61,  71  ;  and  constipation,  181-2  ; 
hereditary?  391  et  seq,  183-4,  381-434;  causes  of,  381; 
preventible,  383  ;  and  panic,  382  ;  and  laboratary  experi- 
ments, 383  et  seq  ;  and  food,  387  et  seq  ;  and  the  King, 
389  et  seq ;  incurable,  395  et  seq ;  from  without,  398  ; 
and  bodily  temperature,  401 ;  and  injury,  403,  438 ;  and 
heredity,  405  et  seq,  519 ;  and  children,  409 ;  and 
domestic  animals,  412 ;  and  sex,  414  et  seq ;  once  can- 
cerous always  cancerous,  393 ;  and  women,  420  et  seq ; 
and  regular  living,  424 ;  and  misery,  424 ;  and  poverty, 
424 ;  and  anxiety,  425  et  seq  ;  and  low-lying  districts, 
426 ;  and  salt,  429  et  seq ;  and  Jews,  429-30  ;  reducible 
and  preventible,  433  et  seq  ;  evolution  of,  441. 

Carbon,  carbonic  acid,  4,  269. 

Carbonaceous  or  carboniferous  foods,  144. 

Carditis,  226. 

Catatribsemia.  From  Kara  =  down  or  intensely,  and  Tpifieiv 
=:  to  rub  or  waste,  and  alfxa  =  blood  ;  the  condition  in 
which  the  blood  is  loaded  with  waste  products,  307,  472  ; 
see  anaemia,  triphthsemia. 

Category,  93. 

Causation.  And  bacillus  tuberculosis,  443  ;  and  constant 
association,  443  ;  see  day  and  night,  also  micro-organisms. 

Causes.  Of  disease,  53-125 ;  and  occasion,  320-1,  122,  438 
et  seq ;  essential  and  accidental,  324  ;  contributory,  37, 
82,  125 ;  proximate,  exciting  and  predisposing,  82 ;  of 
fevers   and   influenza,    111    et  seq;    same  causes   induce 


543 

opposite  states,  216-9  ;  constant,  effects  intermittent,  472 
ei  seg ;  of  psoriasis,  329  ;  and  prevention  of  disease,  1^ 
436  et  seq. 

Celsus,  92,  115  ;  on  circulation  of  blood,  130-1  ;  practice  of, 
140,  509,  528,  535-6. 

Cerebration.    And  food,  233  ;  too  great,  245  ;  defective,  262-4. 

Chambers,  Dr.  King,  195,  240,  282,  288  et  seq ;  510. 

Changing  and  fixed,  341. 

Chewing,  see  Mastication.     Checked  and  clogged,  266-7. 

Checkley,  535. 

Child,  children.  Eating  once  a  day,  303  et  seq ;  feeding  of, 
352-80;  and  hereditary  disease,  406-10  (see  also 
heredity)  ;  and  anxiety,  352  ;  and  errors  of  diet,  353  ; 
ancient  views  of  feeding  of,  356 ;  mortality  of,  357 ; 
growth  of,  357  et  seg;  neglect  and  over  indulgence  of, 
359  ;  interest  of,  365  et  seq ;  and  love  of  sweets,  366 ; 
from  five  to  fifteen  years  of  age,  368  et  seq ;  and  fevers,  369 
et  seq  ;  and  schools,  377  et  seq  ;  and  cancer,  409 ;  and 
food,  410  et  seq. 

Chill-blains,  438. 

Choked.     With  too  much  food,  295. 

Choroid  plexuses,  161. 

Chronic.     Of  disease,  92  et  seq. 

Chyle,  149.     Chyme,  148. 

Cicero,  92,  492.     Circle,  without  beginning  or  end,  142. 

Circular.     Reasoning,  11 ;  fibres,  85. 

Circulation.  Diseases  of,  58 ;  when  discovered,  126  ;  changeEf 
in  practice  from  discovery  of,  126  ;  of  blood  and  lymph, 
practical  bearings  of,  136-8,  154  ei  seq  ;  and  food,  232  ;  in 
sleep,  313. 

Clarke,  Sir  A.,  511.     Climate,  56. 

Clogged  and  checked,  266-7.     Clover  and  basic  slag,  172-3. 

Clubs,  for  exercise,  533. 

Coats  of  arteries,  longitudinal  and  transverse,  187-92. 

Coccus  of  erysipelas,  482. 


544 

Cold,  54-5  ;  and  hot,  192.     Colds  and  food,  273. 

Complexio  vel  alternatio,  210. 

Connective  tissue,  226,  et  passim ;   see  Initis,  312  ;  dumping 

ground  of  blood,  399,  451,  314  et  seq. 
Conscious  of  unhealthy  organs,  153. 
Constipation.     And   alcohol,    76-7 ;    pathology   of,    77,    210  ; 

cure  of,    78  ;    from  starvation,   177  ;    from  over-feeding, 

178  et  seq ;    and  purgatives,   180  ;    and  cancer,   181-2  ; 

hereditary?  183-4;  and  diarrhoea,  194. 
Constitution,  337-9. 
Consumption,  29,  57-8  :  in  British  Army,  330-1  ;  evolution  of, 

441. 
Contracting  or  shrinking,  82  et  seq. 
Contrary  and  contradictory,  186,  249,  347. 
Contributory  causes,  37-9. 
Convulsions,  61. 
Cornaro,  283  et  seq,  379. 
Corns,  438. 

Corpuscles,  see  blood  and  lymph. 
Council,  medical,  municipal,  296. 
Country  man,  525. 
Create.     Body  cannot  create,  269. 
Creation  transcends  wit  of  man,  135,  173. 
Crick  in  neck,  468.     Cricket,  531. 
Crops,  bad,  and  short,  123. 
Cure  and  prevention,  437. 

D. 

Damp.     And  cancer,  427 ;   and  rheumatism  ;   a  contributory 

cause  of  illnesses,  427. 
Dante.     Physiological  ideas  of,  132-3. 
Darwin,  Charles.     Anticipation  of  theory  of  pan-genesis  (from 

TToiJ^  =  all  or  everything,  and  ytvofiai  =  I  become),  370 

et  seq. 
Davis,  Professor,  201,  206,  245,  272,  277. 
Day  and  night,  305. 


545 

Death-rates,  see  Mortality. 

AeiTTVov,  267. 

Defects,  visual,  503  et  seq. 

Definition.     Of  health,  18-20  ;  of  disease,  18,  220 ;  of  arteries, 
163. 

Delicate  child  and  food,  370  et  seq. 

Delirium  tremens,  74. 

Depression,  8. 

Deprivation,  of  air,  food,  &c.,  230. 

Desire.     For   gain,   for  food,  216-9  ;    and   self-restraint,   508 
et  seq. 

Dewey,  Dr.,  66,  141,  246-7,  320,  457,  510,  523. 

Diabetes.     Cases   of,    242-5 ;    theory   of    treatment   of,    243  ; 
Professor  Davis  on,  245. 

Diarrhoea  and  dysentery.  Mortality  from,  61 ;  and  constipa- 
tion, 194. 

Diathesis,  341  et  seq. 

Diet,  see  food.  Eestriction  of,  theory  of,  175  ;  in  opposite 
states,  194  et  seq ;  in  excess  of  function,  242-9  ;  in  defect 
of  function,  249-54 ;  in  slow  pulse,  250-1  ;  in  attenua- 
tion, 254-6  ;  in  anaemia,  256  ;  in  defective  respiration, 
256-8 ;  in  defective  renal  action,  258-9 ;  in  too  low 
temperature  of  body,  259-62  ;  in  defective  cerebration, 
262-4  ;  and  disease,  case  of,  279  et  seq  ;  in  insanity,  320  ; 
full  diet,  278  ;  subsistence  diet,  287  et  seq  ;  errors  of,  in 
children,  353,  353  ;  the  chief  cause  of  disease,  436 ; 
cause  of  bronchitis  and  asthma,  444-60  ;  and  broncho- 
pneumonia, 453 ;  and  pneumonia,  460  et  seq ;  and 
rheumatism,  and  gout,  463-71  ;  and  skin-diseases,  480  et 
seq ;  and  micro-organisms,  483  ;  and  pruritus  and 
eczaema,  486  et  seq ;  and  ulceration,  494  et  seq ;  and 
scrofulous  ulceration.  497  et  seq  ;  and  malaria  and  ague, 
453. 

Difference  of  opinion  among  medical  experts,  9. 

Difficulties  of  medicine,  86-7. 
II 


546 

Digestion.  Digestive  processes,  143-66  ;  time  required  for, 
147,  167  et  seg  ;  a  labour,  284  ;  at  two  stages  in  the  same 
stomach  at  same  time,  285  :  slow,  301  ;  and  exercises, 
528,  536. 

Dilatation.     Or  swelling,  82  et  seq,  210  ;  of  pupils,  502  et  seq. 

Disease,  diseases.  Alimentary,  54  ;  causes  of,  68,  82  ;  one, 
128,  451,  526  ;  departure  from  normal,  128  ;  and  food, 
141,  231  et  seg;  279  et  seg,  435,  522  ;  transmitted,  rarely, 
183,  331  ;  respiratory,  53-7,  72,  151  ;  tubercular,  58, 
494  ;  circulatory,  58,  72  ;  digestive,  64,  74,  226  ;  nervous, 
85  ;  starvational,  66 ;  local  and  general,  136-8  ;  hot  and 
cold,  moist  and  dry,  192  ;  immense  number  ol,  152  ;  and 
functional  change,  220  et  seg ;  and  health,  220  ;  accom- 
panied by  exudation,  224 ;  heredity  of,  327-51  ;  of 
literary  character,  511-6  ;  in  families,  333  et  seg  ;  caused 
chiefly  by  diet,  101,  436,  516  et  seg. 

Disgrace.     And  influenza  with  complications,  335. 

Dissiteism.  For  etymology,  see  siteism,  sitia,  251  ;  as  cure 
of  disease,  435-522 ;  starvation  diet  ?  496  ;  and  visual 
defects,  503  et  seg  ;  479. 

Dogma.     And  bronchitis  and  asthma,  454. 

Dowd,  534. 

Duct,  thoracic,  150-165. 

Dulness,  mental,  233-4. 

Duration  of  life,  26,  273. 

Drainage.     Of  land,  306-7  ;  of  lymph,  306. 

Dry  and  moist,  192. 

E. 

Eating.  To  satiety,  146  ;  slowly,  147  ;  frequently,  237 ;  once 
a  day,  302  et  seg  ;  times  of,  325 ;  see  Food  and  Diet. 

Economy  of  Nature,  165. 

Bgesta,  271,     Eczaema,  487. 

Eilemma,  or  Ilemma,  etXe/i^a.     A  covering,  228. 

Element.     "Water,  83. 

Emphysema,  449.  A  Greek  word  adopted.  'E/xc^vcny/aa  = 
inflation  or  over-distension  (of  air-cells). 


547 

End-eilemmatons,  228. 

Energy  and  food,  266. 

Enteritis,  23,  226. 

Environment      And  organism,   174 ;    and  heredity,   183,  339 

et  seg. 
Epidemics.      Of     disease,    124.       From    e77t    =    upon,    and 

SrjfJLOS  =  the  land,  and  hence  the  people  who  Hved  on  it. 
Epilepsy,  604-7|;  the  sacred  disease,  605. 
Equation.     Personal,  15.     Erasistratus,  523. 
Eructate  food,   299.     Erysipelas,  480   et  seq.      E/avtrtTreXacr 

from  ipvOpoq  =  red,  and  TreXXa  =  sMn. 
Essence  and  accident.     Essential  and  accidental,  480. 
Etimation,  low,  of  medical  profession,  253. 
Eternal  and  temporal,  341.     Evans,  Dr.  A.,  44. 
Evidence.     Probable  and  demonstrative,  184. 
Evolution.     Of  cancer  and  tuberculosis,  441. 
Exciting  causes  of  disease,  87-8.     Ex-enteritis,  228. 
Ex-ilemmatous,  228. 
Exercises,       In     peliosis,      323 ;     effects     of,     523-37 ;     and 

digestion,  628-36. 
Exercitatio,  527.      Expectant  mother,  363  et  seq. 
Exo-typhhtis,  228. 
Expectation  of  life,  26-36. 
Experiment.     Natural  and  artificial,  184. 
Exudation  in  disease,  153-224. 

F. 

Face.     Erysipelas  of,  480  et  seq ;  family  disease,  333  et  seq. 

Fasting.  How  beneficial,  285  ;  raises  too  low  temperature, 
285 ;  and  loss  of  weight,  286  et  seq ;  and  blood- 
corpuscles,  290-2  ;  for  weeks,  292  ;  and  insanity,  320  ; 
in  epilepsy,  505. 

Fatigue  after  eating,  300,  308-9,  312.     Fats,  145. 

Feeding.  Of  infants,  45,  288 ;  wrong  feeding  the  chief 
cause  of  disease,  101 ;  of  children,  352-80 ;  see  Food. 

Fehleisen,  482.     Fencing,  531. 
II  2 


548 

Fever  and  ague,  106 ;  and  quinine,  107. 

Feverish  cold,  110. 

Fevers,  2.  Causes  of,  3,  64.  And  food,  102.  And  bad  air, 
111  et  seq.  And  starvation,  120  et  seq.  And  infection, 
369. 

Fibres.  Longitudinal  and  transverse,  85,  484  et  seq.  Eelation 
to  constipation  and  anaemia,  77. 

Fixed  and  changing,  341. 

Fluids  required,  326.     See  alchohol. 

Food.  Amount  taken,  4,  57 ;  a  cause  of  disease,  68,  90,  231 
et  seq,  271  ;  kinds  of,  143  ;  nitrogenous  and  carbon- 
aceous, 144;  over- ingestion  of,  M7  ;  makes  blood,  151, 
265  :  and  function,  236  ;  and  insanity,  246-7 ;  how 
much  required,  265-326,  323,  448  ;  and  energy,  266  ;  and 
physiology,  275  et  seq  ;  too  much,  272,  448  ;  of  royal 
navy,  289  et  seq;  and  "colds"  and  influenza,  273;  eructation 
of,  299;  fatigue  after,  299,  309,  312;  and  alcohol,  311; 
flesh  off  323  ;  and  cancer,  387  et  seq  ;  as  cause  and  cure  of 
disease,  435-522;  see  diet. 

Football,  531.     Foreign  matter  in  blood,  400  et  seq. 

Forster,  325. 

Full  diet,  278. 

Function.  Defect  of,  9  ;  defective,  excessive,  irregular,  215 
et  seq  ;  and  structure,  134-6 ;  and  property,  208  et  seq  ; 
and  disease,  220  et  seq  ;  and  stimulus,  228  et  seq ;  propo- 
sitions regarding,  236 ;  and  food  supply,  236  ;  excess  and 
defect  of,  treatment  of,  242  et  seq ;  of  food,  to  make 
blood,  265;  to  nourish  the  body,  265 ;  checked  and 
clogged  ;  of  skin,  changes  in  feeding  of,  493-4. 

G. 

Galen,  92,  127,  473 ;  on  pulse,  131. 

Games,  525  et  seq. 

Gastric  juice  or  acid,  146. 

Gesiatio,  527.     Gin-drinker's  liver,  346. 

Gout,  72  ;  and  injury,  403. 


549 

Gravitation.     Law  of,  309. 

Greeks.     And  opposites,  208. 

Giimpel  (Godfrey),  430-1. 

Gun-shot  wound,  328. 

Haddon,  Dr.,  304-6.     Haigh,  Dr.,  282. 

Harvey,  Dr.,  126. 

Headaches.     And  diet,  479  et  seg. 

Health.     And  disease,  220  ;  definition  of,  18-20. 

Heart.     Quantity  of  blood  in,  156. 

Heat,  54-5  ;  mechanical  equivalent  of,  266  ;  and  fuel,  270. 

Hemiplegia,  67.      (From  e)u,i   =  half  and  Trkiqyrj   =    a  blow 

or  stroke.     Used  of   the  condition  in  which  one  half  of 

the  body  is  struck  or  paralysed. ) 
Heredity  of  disease,  327-51 ;  law  of,  329 ;  definition  of,  340-1 ; 

ancient  views  on,  242  et  seq ;  of  rheumatism,  469  et  seq. 
Hippocrates,  99,  100,  116-7,  140-1,  305,  451,  509. 
Holt,  Professor,  360. 
Hot  and  cold,  192-3,  235. 
Humiliation.      And  Influenza,  325. 
Hysteria,  315  ;  see  initis.     (From  varepov  =  uterus  =  womhi- 

ness,  therefore.      An  absurd  name  for  a  disease,  which 

men   may   manifest   as  well   as  women.     As  used,  it  is 

synonymous  with  flightiness,  irregularity  of  mentalisation, 

&c.) 

I. 

Indies,  West,  106-7,  453. 

Infant  mortality,  49-9,  24  ;  feeding,  45,  288,  354  et  seq ;  see 

children. 
Infection.     And  fevers,  369,  403  ;  keeping  away  from,  443. 
Infirmaries  and  bread,  2  ;  numerous,  10,  102  ei  seg ;  recurrence 

of,  105 ;  Stages  of,  464 ;  specific,  484. 
Influenza.     Mortahty  from,  62-4  ;  recurrence  of,  104  ;  causes 

of,    112   ei   seq ;   and   food,    273 ;     and   humiliation   and 

disgrace,  335  ;  and  infection,  443-4. 
Inheritance ;  see  heredity. 


550 

Ingesta,  270. 

Initis.  •|;(From  tcr  =  vis  =  strength.  The  word  therefore 
means  affection — generally  inflammation — of  strong  or 
connective^tissue),  225  :  relation  to  other  diseases,  314 
et  seq,  451  ;  see  rheumatism. 

Injury,  2  ;  and  gout  and  cancer,  403. 

Insane.     Insanity,  222,  247  ei  seq,  320. 

Insomnia];  see  sleeplessness. 

Intermittent.     Of  disease,  94,  472  et  seq. 

Intestinal  villi,  149. 

Intestines,  149,  153,  498  et  seq. 

Itis.     Termination  ;  meaning  of  227. 

J. 

Jews.     And^cancer,  429-30. 

Job,  337.     Joule,  266.     Juries,  502. 

K. 

Kibroth-Hattaava,  3. 

King  and  cancer,  389  et  seq. 

h. 

Laboratory  experiments,  385  et  seq. 

Labour  of  digestion,  284. 

Lacteals,  150-65. 

Land.     Drainage  of,  306-7. 

Laryngismus  stridulus,  67. 

Latins.     Names  of,  for  opposite  states,  207-8. 

Laxum  et  strictum,  208  et  seq. 

Law.      Of  opposite   states,   207-8 ;    of    gravitation,    308 ;    of 

heredity   in  disease,   328  ;  declared  by  medical  or  other 

interpreter  of  nature,  308. 
Leaping,  531. 
Liable,     And  subject,  333. 
Liebig,  143-4,  266. 
Life.     Expectation  of,  duration  of,  26,  273 ;  worth  living,  28  ; 

early  in,  333. 


551 

Line.     Drawing  the,  224.     Ling,  534. 

Lip  cancer,  403. 

Liver,  148, 150  ;  alteration  in  size  of,  154-5  ;  empty,  fuU,  155-7. 

Living.     Plain,  and  high  thinking,  161. 

London  and  Eome.     Parallel  between,  118-20. 

Long.     Of  disease,  97. 

Loss  of  weight  in  fasting,  286  et  seq. 

Lungs,  150  ;  blood  in,  156. 

Lymph.     In  brain,    161  ei  seq ;    what  ? ;    comes  from   blood, 

163 ;   spaces,    164  st  seq ;    and  economy  of  nature,   165 ; 

overplus  of,  168  et  seq  ;  and  tubercle-bacillus,  172  et  seq  ; 

corpuscles,  163  ;  drainage,  307,  317  et  seq. 
Lymphatic  glands,  163  et  seq. 

M. 

Malarial  fever,  106-9  ;  and  over-feeding,  109,  453. 

Martin,  Saint,  297  et  seq. 

Mastication,  143,  145,  148.     Materies  morbi,  272. 

Meals.  Number  of,  113  et  seq ;  of  paupers,  114  ;  of  soldiers, 
114 ;  of  Eomans,  115-6,  509,  515  ;  in  navy,  114 ;  once  a 
day,  497  ;  see  food,  feeding,  and  children. 

Mechanism.     Bodily,  133.     Medical  council,  295. 

Medicine,  1,  6  ;  difficulties  of,  13  ;  chaos  and  simplicity  of, 
151  ;  paradoxes  of,  176-264 ;  rival  schools  in,  212 ;  and 
business ;  parallel  between,  216-9 ;  aim  of,  396. 

Membranes.     Serous  and  other,  166. 

Mentalisation ;  see  cerebration. 

Micro-organisms.  And  disease ;  and  laboratory  experiments, 
385 ;    see  bacillus,  coccus. 

Middlemarch,  373.     Milby,  373. 

Mild.     Of  disease,  92  et  seq. 

Milk.  And  calories,  248,  304  et  seq ;  for  infants,  354  ;  com- 
position of.  354 ;  human  and  bovine,  354  et  seq  ; 
laboratories,  355. 

Millionaires,  385  et  seq. 

Moderation.     The  only  rule,  81,  294,  522  ;  in  alcohol,  311. 


552 

Moist  and  dry,  192.     Moleschott,  277  et  seq. 

Monositeous  ;  see  siteism,  468,  479 

Morbtis  misericB,  424  et  seq. 

Mortality.       Zymotic,    28-81  ;    from    consumption,    29,    37  ; 

infant,  48,  240  ;  under  five  years,  69  ;  over  65  years,  70  ; 

groups  of,  71-5  ;  old  age,  73 ;  from  alcohol,  74-81. 
Moses.     And  fevers,  3  ;  mosquito  bites  ;  and  malaria,  109. 
Mothers.     And  infants,  240-1 ;  nursing,  289  et  seq ;  expectant, 

363-5 ;  prejudices  of,  373  et  seq. 
Movements.     Passive  and  active,  530. 
Municipal  Councils,  295. 
Muscles.      Of    back,   and   internal  affections,  139;    blood  in, 

155  ;  for  motion  and  v?ork,  156 ;  membranes,  166. 

N. 

Nature.     Indications  from,  for  treatment  of  disease,  101. 

Navy.     Eoyal,  298.     Navvy,  in  a  sewer,  212. 

Neuralgia.     Neurosis,  226,  317  et  seq  ;  see  initis. 

Neuritis,  226.     Night  and  day,  305. 

Nils-posse,  535. 

Nitrogen.     Nitrogenous  foods,  144,  269. 

Non-nitrogenous  foods,  145. 

Number.     Proportional,  53  et  seq. 

Nutrition.     And  food,  232,  254  et  seq. 

O. 

Occasion.     And  cause,  122,  320. 

Oddfellows.     Sickness  among,  273  et  seq. 

Old-age,  58-73. 

Opposite.     And  contrary  and  contradictory,  186,  195. 

Opposition.     In  treatment,  190-193. 

Organ,    organs.       Interactions    between,    137  ;    healthy    and 

unhealthy,   152-3, 
Organisation.     Transmitted,  183.     See  heredity. 
Oribasius,  356. 


553 

Over-feeding.  Effects  of,  166  et  seq  ;  signs  of,  177  et  seq  ;  and 
constipation,  178  et  seq  ;  increases  and  diminishes  weight, 
195  ;  treatment  by  over-feeding,  vyhat  it  really  is,  196- 
219  ;  apt  to  cause  illness  later,  202,  206  ;  lowers  powers, 
213  ;  causes  over-growth,  397  ;  and  under-feeding,  514. 

Over-growth.     Cause  of,  397. 

Over-work.     In  two  directions,  524-5. 

P. 

Panacea,  521. 
Pancreas,  148. 
Pan-genesis  (from  Trd.J'  =  all  or  every  part ;  and  yivofxaL  =  I 

become,  meaning  that  the  new   creature  becomes,  or  is 

formed   by   gemmules   coming   from    every   part   of    the 

parents),  345. 
Panic.     And  boom,  216-9,  513. 
Paradoxes  of  medicine,  176-264. 
Paralysis,  210. 

Parasite.     And  treatment,  492-3.     Parenchyma,  227. 
Pathology.     And  physiology,  151. 
Peace.     Not  obtainable  by  surrender,  207. 
Peliosis  or  pehdnosis,  322. 
Per-acute,  92. 
Peri-carditis  (Trepl  =  around ;    used  of   the  structure  which 

surrounds  an  organ ;  in  this  case  the  heart  ^  KapSta^ 

and  signifying  inflammation  of  the  membrane  surrounding 

the  heart,  or  the  peri-cardium),  226,  228. 
Peri-enteritis,  226,  228  (inflammation  of  the  serous  membrane 

and  connective  tissue  surrounding  the  bowel). 
Peri-neuritis   (inflammation  of   the  sheath  or  covering  of    a 

nerve,  vevpov  =  sinew,  or  nerve  ;  but  the  latter  not  till 

Galen's  time),  226. 
Peri-typhilitis  (nepl  and  TV<f)Xov,  inflammation  of  the  parts 

surrounding  the  ccecum),  23,  226. 
Pernicious  anaemia,  498. 
Philosophical.     View  determining  treatment,  138. 


554 

Phreaitis,  129  {(f>pr]v  =  midrifif ;    heace  the  seat  of  courage ; 

hence  the  organ  of  courage,    or  later,   of    wit  or  sense ; 

hence  phrenitis  came  to  mean  inflammation  of  the  brain). 
Phthisis    (f>dC(TL^,  (from  <f>OL(ti   or    <^9ivoi   =    I    waste) ;    see 

consumption. 
Pigs,  and  cancer,  412.     Pilgrim,  Mr.,  and  Mr.  Pratt,  373. 
Pills.      Cockles',  Morrison's,  HoUoway's,  76  ;  see  constipation. 
Plethora,  121.     Plexus,  choroid,  161. 
Pneumonia,  53,  212  ;  and  diet,  460  et  seq. 
Pollaki-amylism,    448    (nokXaKLcr    =    often,    and   amylism ; 

taking  starchy  food  too  often). 
Poly-amylism,    448    {iroXva-    =    much ;    and    djxvXov ;    see 

amylism). 
Pollaki-siteism.  516  (7roX\a/cto'  and  siteism,  which  see). 
Poly-siteism,  516. 
Poor,  eat  too  often,  237,  353. 
Portal  vein,  149,  153-4. 
Poverty,  237  et  seq. 
Predisposing  causes  of  disease,  88-9. 
Predisposition,    54-5  ;    and  resistance,  334  et  seq ;    made  by 

ourselves,  440. 
Preece,  535. 
Prevention.     Of    disease,    1-4  ;    of    cancer,   390    et  seq ;    and 

causation,  436  ;  and  cure,  437. 
Principle  and  accident,  238. 
Proof,  wearisome,  490. 
Property  and  function,  208  et  seq. 
Prophasiology,  438. 
Prophecy,  22. 

Proportional  number,  53  et  seq. 
Prosagory,  93. 

Pruritus.     Eelation  to  diet,  486  et  seq. 
Psoriasis,  327  et  seq  ;  causes  of,  329. 
Pulmonary  artery,  150 ;  veins,  151. 

Pulse.     And    ancient    physicians,     127,    130-1  ;    and    blood- 
letting, 339. 
Purgatives.   Uselessness  of,  in  constipation,  180 ;  kinds  of,  180. 


555 
Q. 


Quinine  in  malaria,  107. 


E. 

Eanke,  275  et  seq,  325.     Reading  aloud,  529. 

Reasoning,  Circular,  11-13. 

Recurrent.     Disease,  472  et  seq  ;  headaches,  479. 

Registrar- General,  25. 

Regular  living.     In  wrong  way,  424. 

Relapsing  fever,  121.     Relaxant,  211.     Relaxing,  87. 

Remittent,  94,     Renal  action,  and  food,  233,  258-9. 

Reservoir,  384. 

Resistance.     Low,  11,  56;  and  predisposition,  54-5,  534. 

Respiration.     And  food,  232,  256-8. 

Respiratory  diseases,  53  et  seq,  72. 

Rest,  after  eating,  147.     Restraint,  508  et  seq. 

Restriction  of  diet.     Theory  of,  175  :  in  opposite  states,  487  ; 

in  ulceration,  496. 
Rheumatism,  71  ;  caused  by  diet,  463-71 ;  etymology  of,  463  ; 

what  it  is,  464 ;  see  initis. 
Rich  eat  too  often  and  too  much,  237.     Richards,  Mrs.,  325. 
Rome.     Roman   soldiers,    115    et  seq ;    and   London,  parallel 

between,  118-20. 
Rotation.     Of  earth,  95 ;  of  moon,  96. 
Eowntree,  Mr.  Seebohm,  289.     Rumford,  Count,  266. 
Running,  529.     Rush  and  torpor,  533. 

S. 

Saint  Martin,  297  et  seq.     Salisbury,  Dr.,  447-8. 

Saliva,  salivary  glands,  145. 

Salt.     And  cancer,  429  et  seq. 

Sane,  222.     Sanitary,  sanitation,  27,  36. 

Sarco-lemma,  156.     Sarcoma,  396,  398, 

Satiety,  eating  to,  146-7.     Schools,  and  children,  377  et  seq. 

Schreber,  634. 

Scrofula.     Etymology  of,  442.     Scrofulous  ulceration,  497. 


556 

Secobiensis,  Andreas  Lacuna,  473. 

Seed,  and  soil,  172-3,  403.     Self-restraint,  433,  477. 

Sex.  And  cancer,  414  ;  and  habit,  414  et  seg ;  and  suicide* 
426  ;  and  religion,  426, 

Short.     Of  disease,  92  ei  seg. 

Shrinking  and  swelling,  96  et  seq,  208,  513. 

Sinking.     Feeling  of,  465. 

Siteism,  or  Sitia.  The  taking  of  food  (from  crtro?  = 
wheat  or  corn ;  used,  of  bread  ;  hence  monositeism  or 
monositia,  eating  once  a  day  from  fxovoq  ;  monophageism 
or  monophagia  is  used  of  eating  alone,  some  persons 
being  both  monositeous  and  monophageous ;  hence  dis- 
siteism  or  dissitia,  trissiteism  or  trissitia,  tetrasiteism  or 
tetrasitia,  pentasiteism  or  pentasitia,  hectasiteism  or 
hectasitia,  octositeism  or  octositia,  and  decasiteism  or 
decasitia,  for  eating  two,  three,  four,  jfive,  six,  eight  or 
ten  times  a  day ;  pollaki-siteism  or  poUaki-sitia,  and 
poly-siteism  or  poly-sitia,  the  act  of  eating  too  often, 
TToXXct/cicr,  or  too  much,  ttoKvs  ;  oligaki-siteism  or 
oligaki-sitia,  and  oligo-siteism  or  oligo-sitia,  the  act  of 
eating  too  seldom,  oXtyct/ctcr  =  seldom,  or  only  now  and 
then  ;  and  too  little,  oXtyo?  =  little  or  small). 

Skin  eruptions.  And  alcohol,  78  ;  and  diet,  480  et  seq  ;  hot, 
dry,  moist,  cold,  &c.,  192-3:  235. 

Slag.     Basic,  172-3. 

Sleep.  Sleeplessness  ;  and  starvation,  177  ;  from  opposite 
causes,  186-7  ;  and  disease,  224  ;  and  circulation.  413  ; 
treatment  of,  169. 

Slow.     Eating.   147  ;  digestion,  301. 

Smith,  letter  of,  456-7,  523. 

Soil.     And  seed,  172-3,  403. 

Soldiers.  And  gun-shot  wound,  328  ;  in  a  narrow  pass,  252  ; 
and  death  from  starvation,  293-4. 

Solutio,  208  et  seq. 

Specialism.     Specialist,  129. 

Spencer,  Herbert,  19. 


557 

Spirits.     Animate  or  nervous,  vital  or  sanguineous,   animal  or 

digestive,  132-4,  161. 
Spring.     Compressed  and  uncoiled,  95. 
Stagnation  and  activity,  513. 
Staphylococcus  aureus  et  albxs,  490  et  seq.      (From  (rTa(f)v\.rj 

=  a  bunch  of  grapes,  and  kokkos  =^  a  rounded  kernel, 
meaning  a  micro-organism  with  a  rounded  enlargement 
like  a  grape). 

Starch  and  disease,  81 ;  in  foods,  145. 

Starvation,  293  ;  and  fevers,  120  et  seq  ;  effects  of,  121  et  seq  ; 
and  sleep,  177 ;  direct,  179 ;  and  indirect,  267-9 ;  of 
over-repletion  or  over-feeding,  195,  240,  282  ;  starvation 
diet,  197  :  death  of  soldiers  from,  293-4 ;  and  ulceration, 
496  et  seq. 

Steam  engine,  142-3. 

Stewart,  Professor,  54. 

Stimulus.     And  function,  228  et  seq,  229,  236. 

Stomach.     Capacity  of,  355  et  seq. 

Strictum  et  laxum,  208  et  seq.  513. 

Structure  and  function.     Four  views  on  relation  of,  134-6. 

Struma.     Senile  and  juvenile,  497. 

Sub-acute,  92. 

Subject.     And  liable,  333. 

Subnormal  temperature.  And  fasting,  286  et  seq  ;  subsistence 
diet,  287  et  seq. 

Suffering,  521.     Sugar.     Function  of,  in  food,  146. 

Surgery.     Too  much,  21,  321  ;  safer  than  before,  24-5,  520. 

Surrey  and  Sussex  fowls,  195  et  seq. 

Swallowing,  146.     Swedish  Ling,  534. 

Swelling  ;   see  shrinking.     Sycosis,  490. 

Sydenham,  63,  510.     Syndesmitis,  466. 

T. 

Tao-ts  KoX  XaXaort?  (stretching  and  slackening),  208,  513, 
Tea.     Afternoon,  285,  310. 


558 

Temperature  of  body,  high  and  low,  192  ;  and  hot  drink,  200  ; 
low  temperature,  how  caused,  214  et  seq  ;  and  food,  233, 
259-62  ;  low  temperature  raised  by  fasting,  286  ei  seq  ; 
low  temperature  before  cancer  appears,  401. 

Temporal.     And  eternal,  341. 

Tenonitis,  464.  (Inflammation  of  a  tendon  from  reivav  =  to 
stretch,  because  a  tendon  stretches  from  attachment  in 
muscle  to  attachment  in  bone.  Tao"t9  =  stretching,  is 
from  the  same  root). 

Thing.     And  thought,  relation  between,  134,  236. 

Thinking.     High,  and  plain  living,  161. 

Thoracic  duct,  150,  165,  210. 

Thought.     And  thing,  134,  236. 

Tinea  harha,  490  et  ssq. 

Tired.     After  meals  ;  see  fatigue. 

Tissue.     See  connective.     Toller,  Dr.,  373. 

Tonic,  87,  211.     Tonsils  removed,  129-30. 

Torpor.     And  rush,  533. 

Total  abstinence  from  alcohol,    123  et  seq. 

Townsmen,  525, 

Transmitted.     Of  disease,  338-50 ;  see  heredity. 

Treatment.  Method  of,  2  ;  by  diet,  medicine,  and  surgery, 
89;  and  philosophic  view,  139;  strengthening  and 
lowering,  87  ;  by  opposition,  poor  treatment,  190 ;  by 
less  amount  of  the  exciting  cause,  202-3. 

Tricycle,  531. 

Triphthaemia.  [Tpl^eiv  =  to  waste  or  rub,  and  alixa  = 
blood ;  meaning,  therefore,  loading  of  the  blood  with 
waste  products) ;  see  anaemia,  catatribaemia. 

Tuberculosis,  57  ;  evolution  of,  441 ;  see  consumption  and 
phthisis. 

Twain,  Mark,  177. 

Typhlitis.     Tv(j)\ov,  23. 


559 

U. 

Ulcer.     Ulceration,  494  et  seq ;  scrophnlous  or  strtimous,  497  ; 

callous,  495  ;  of  bowel  499  et  seq ;  and  direct  starvation, 

500. 
Unconscious  of  healthy  organs,  152. 
Under-feeding.     Signs  of,  176  et  seq. 
Uric  acid,  309. 
Urine,  198-203. 

V. 

Vein.     Portal,  149  ;  hepatic,  150  ;  pulmonary,  161 ;  definition 

of,  163 ;  vena  cava,  149. 
Verdicts,  502.     Villi,  149-     Visual  defects,  403  et  seq. 
Voit,  279. 

W. 

Walking,  529.     War  office,  293. 

Water,  83  ;  deprivation  of,  230.     Watson,  A.  W.,  273. 

Weakening,  87. 

Weight.     Feeling  of,  after  eating,  147  ;  loss  of,  in  fasting,  286 

et  seq ;  growth  of,  in  children,  352  et  seq. 
Women.     And  domestic  work,  526-7 ;  eat  too  often,  416  etseq ; 

and  illness,  417  et  seq. 
Work.     Domestic,  526-7.     Wrench  Dr.,  373. 

X.     Y.     Z. 

Xerxes,  117.     York.     Poverty,  241. 
XaXacrts.     See  Tacrts. 
Zig-zag  action,  96. 

Zymotic  mortahty,  28 ;  diseases,  73  et  seq  ;  and  air  and  food, 
112  g/  seq. 


ERRATA. 

P.  80.     Line  14.     For  pattern,  read  father. 

P.  89.  Line  11  from  bottom.  For  understood,  read  misunder- 
stood. 

P.  182.     Line  9.     For  exised,  read  excised. 

P.  188.  Line  11  from  bottom.  For  hypethoply,  read 
hypertrophy 

The  scholar  will  also  please  to  excuse  one  or  two  errors  in 
accents  on  Gresk  words,  which  it  proved  too  late  to  correct, 
and  to  which  no  further  reference  is  made. 


Toothtlls  Limited,  Printers,  Drewton.  Street  tnd  Godwin  Street,  Bradford. 


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